- Ascension Health (Baltimore, MD)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . Responsibilities: + Review admissions and ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Cognizant (Annapolis, MD)
- …Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… 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 ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Humana (Annapolis, MD)
- …impact** **Use your skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state) with no disciplinary ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- CVS Health (Annapolis, MD)
- …with behavioral health background. **Preferred Qualifications** + 3 years Managed care/ utilization review experience preferred. + Crisis intervention skills and ... Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years… more
- Fresenius Medical Center (Towson, MD)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross… more
- Sharecare (Annapolis, MD)
- …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… 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 ... The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for… more
- Evolent (Annapolis, MD)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current,… 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. ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… 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- ... Registered Nurse in MD, VA or Washington,...working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications** : + Knowledge… more
- CareFirst (Baltimore, MD)
- …experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications** : + Knowledge and experience ... (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely...based on evolving business needs. **Licenses/Certifications** : RN - Registered Nurse - State Licensure And/or Compact… 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 ... RN- Registered Nurse in MD, VA or Washington,...working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Bilingual -… more
- CareFirst (Baltimore, MD)
- …High School Diploma or GED. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure RN- ... Registered Nurse in MD, VA or Washington....experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct… 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 ... Case Manager Upon Hire Preferred. + LNCC - Legal Nurse Consultant Certified Upon Hire Preferred. **Experience:** 5 years...similar clinical experience OR 5 years' experience in Medical Review , Utilization Management or Case Management at… more
- CareFirst (Baltimore, MD)
- …experience. **Experience:** 3 years Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... change based on evolving business needs. **Licenses/Certifications** : Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure… more