- Cognizant (Annapolis, MD)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- CVS Health (Annapolis, MD)
- …we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** utilizes ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Humana (Annapolis, MD)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… more
- CVS Health (Annapolis, MD)
- …both verbal and written **Required Qualifications** - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active ... work schedules will include weekends, holidays, and evening hours._ + Utilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Annapolis, MD)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.… more
- CVS Health (Annapolis, MD)
- …good standing Arizona clinical and/or counseling license, specifically RN ( Registered Nurse ), LPC (Licensed Professional Counselor), LAC (Licensed Associate ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… more
- Fresenius Medical Center (Towson, MD)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- CVS Health (Annapolis, MD)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- CareFirst (Baltimore, MD)
- …required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization...Hire Required + CNS- Clinical Nurse … more
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic...**Preferred Qualifications:** + 2 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield,… more
- Evolent (Annapolis, MD)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- Johns Hopkins University (Baltimore, MD)
- …and rapidly changing environment. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse Practitioner. ... guidelines of the department and institution and in accordance with the Nurse Practitioner-Physician Written Agreement required and approved by the State of Maryland… more
- Johns Hopkins University (Baltimore, MD)
- …team while maintaining patient confidentiality. **Minimum Qualifications** + Master's Degree in Nursing; Registered Nurse license and Certified as a Nurse ... to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast… more
- Sharecare (Annapolis, MD)
- …to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their ... to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they… more
- Johns Hopkins University (Baltimore, MD)
- …fluids with blood borne pathogens. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse Practitioner. ... to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast… more
- CareFirst (Baltimore, MD)
- …subject to change based on evolving business needs. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or Compact State Licensure: RN - ... Utilizing experience and skills in both care management and utilization management, the Onsite Clinical Navigator will... Registered Nurse in MD, VA or Washington,... Registered Nurse in MD, VA or Washington, DC Upon Hire… more
- CareFirst (Baltimore, MD)
- …to the required work experience. **Licenses/Certifications Upon Hire Required** : + RN - Registered Nurse - State Licensure And/or Compact State Licensure RN- ... Utilizing experience and skills in both case management and utilization management, the Onsite Clinical Navigator will...Registered Nurse in MD, VA or Washington,...Registered Nurse in MD, VA or Washington, DC **Experience:** 5… more
- CareFirst (Baltimore, MD)
- …to the required work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - Active State Licensure And/or Compact State Licensure ... **Resp & Qualifications** **PURPOSE:** The Inpatient Management Post Acute Clinical Navigator (RN) manages the timely and smooth transition...RN- Registered Nurse in MD, VA or Washington,… more
- CareFirst (Baltimore, MD)
- …individual and team-based performance as needed. **Licenses/Certifications** : + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate... experience OR 5 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield,… more