• Utilization Management Nurse

    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...appropriate courses of action. As a Utilization Management RN working on the OneHome/ Home Solutions… more
    Humana (09/12/25)
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  • SNF Utilization Management RN…

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (09/12/25)
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  • Utilization Management Manager…

    CareFirst (Baltimore, MD)
    …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... expected to work a portion of their week from home and a portion of their week at a...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
    CareFirst (10/11/25)
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  • Utilization Management Reviewer

    AmeriHealth Caritas (Washington, DC)
    …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
    AmeriHealth Caritas (09/01/25)
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  • Full-Time Home Health Registered…

    Trinity Health (Silver Spring, MD)
    …Counties** **Day 1 Benefits, 10k Sign-on Bonus & More** **Position Overview** As a Home Health Registered Nurse , you'll provide in- home skilled nursing care ... **Employment Type:** Full time **Shift:** **Description:** **Looking for Full-Time Home Health RNs to service our patients in and...savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every… more
    Trinity Health (08/26/25)
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  • Senior Living Program Manager, Nurse

    BAYADA Home Health Care (Catonsville, MD)
    **BAYADA Senior Living Solutions** , a specialty offering of BAYADA Home Health Care, was created to address the unique needs of senior living communities, and their ... Baltimore Counties **_._** Are you a solutions-oriented, team-focused **Registered Nurse , Licensed Practical Nurse or Therapist (Physical...create alignment to common goals across multiple levels of management ? Would you like to be viewed as a… more
    BAYADA Home Health Care (09/04/25)
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  • Disease Management Nurse - Remote

    Sharecare (Washington, DC)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...minimum. + This position will be based in a home office which must satisfy all HIPAA requirements. Sharecare… more
    Sharecare (09/13/25)
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  • Nurse Practitioner (Radiation Oncology…

    Johns Hopkins University (Baltimore, MD)
    …guidelines of the department and institution and in accordance with the Nurse Practitioner-Physician Written Agreement required and approved by the State of Maryland ... and the Nurse Practice Act of the State of Maryland. Is...long-term effects of radiation and provides accurate and timely management for such side effects. + Provides education to… more
    Johns Hopkins University (07/31/25)
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  • Registered Nurse - Post Acute…

    Veterans Affairs, Veterans Health Administration (Washington, DC)
    …Living Center (Freedom Way East) Post-Acute Rehabilitation and Long Term Care Registered Nurse provides care and counseling of persons of health and prevention of ... (Freedom Way East) Post-Acute Rehabilitation/Polytrauma and Long Term Care (LTC) Registered Nurse (RN) provides care and counseling of persons or in the promotion… more
    Veterans Affairs, Veterans Health Administration (10/08/25)
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  • Case Manager, Registered Nurse - Oncology…

    CVS Health (Annapolis, MD)
    …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.**...or Specialty Pharmacy. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
    CVS Health (10/02/25)
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  • Consultant, Nurse Disability I

    Lincoln Financial (Washington, DC)
    …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at ...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
    Lincoln Financial (10/10/25)
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  • Appeals Nurse

    Evolent (Washington, DC)
    …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
    Evolent (10/11/25)
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  • Nurse Supervisor - Dialysis

    Trinity Health (Silver Spring, MD)
    …high-quality care to patients with complex renal needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment Type:… more
    Trinity Health (10/02/25)
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  • Part-Time (24 Hours) Home Care RN…

    Trinity Health (Silver Spring, MD)
    …Type:** Part time **Shift:** Weekend Shift **Description:** **Position Purpose:** Our Home Care RNs (Primary Care Nurses) provides primary nursing care to ... home based care patients as ordered by the physician,...and LPNs as needed. Provides therapeutic intervention, overall care management and achievement of top decile client outcomes and… more
    Trinity Health (09/15/25)
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  • Care Management Supervisor (Hybrid)

    CareFirst (Baltimore, MD)
    …Active State Licensure and/or Compact State Licensure. **Experience:** 5 years experience in Utilization Management or Case Management at CareFirst BlueCross ... **Resp & Qualifications** **PURPOSE:** The Care Management Supervisor supervises, directs and coordinates the activities...care costs. **We are looking for an experienced Registered Nurse and people leader with UM/CM experience** **living within… more
    CareFirst (10/01/25)
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  • Clinical Navigator (Remote)

    CareFirst (Baltimore, MD)
    …years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications:** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both case management and utilization management including… more
    CareFirst (10/11/25)
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  • Onsite Clinical Navigator (Hybrid)

    CareFirst (Baltimore, MD)
    …years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications:** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both care management and utilization management , the… more
    CareFirst (10/09/25)
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  • Clinical Navigator (Onsite)

    CareFirst (Baltimore, MD)
    …5 years clinically related experience working in Care Management , Home Health, Discharge Coordination and/or Utilization Review. **Preferred Qualifications** ... the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and...of care. Utilizing experience and skills in both case management and utilization management , the… more
    CareFirst (08/14/25)
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  • Care Manager (Remote)

    CareFirst (Baltimore, MD)
    …or Washington. **Experience:** 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review, ... **PURPOSE:** This position will support the Maryland government programs care management team, specifically the Medicare Advantage line of business. The Care… more
    CareFirst (10/10/25)
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  • Care Manager - MD/DC/Northern VA (Remote)

    CareFirst (Baltimore, MD)
    …or GED **Experience:** 5 years clinically related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review, Disease ... in nursing + CCM/ACM or other RN Board Certified certification in case management . Federal Employee Program (FEP) Book of Business (ONLY): Must have CCM/ACM or… more
    CareFirst (09/23/25)
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