- Luke Staffing (Bethesda, MD)
- …+ Comply with regulatory, MTF, and Joint Commission quality inspection/ peer review / utilization management requirements, and applicable system applications. ... needs. + Evaluate procedures/methods including but are not limited to: the review of medical record, subjective interview with patient and/or family/caregiver and/or… more
- Luke Staffing (Bethesda, MD)
- …+ Comply with regulatory, MTF, and Joint Commission quality inspection/ peer review / utilization management requirements, and applicable system applications. ... and able to work with various personalities. Team work skills required. Time management skills required. The ability to meet deadlines in a deadline intensive… more
- Coty (Hunt Valley, MD)
- …are opportunities for improvement. **RESPONSIBILITIES** This role is part of Operations management team and reports to the Operations Department Manager. As an ... line and tracking of non-productive time and equipment down time + Enforcing utilization of Ignition by all technicians to make data driven production decisions +… more
- Washington Metropolitan Area Transit Authority (Washington, DC)
- Manager, IT Asset Management Job ID: 260053 Location: DC/MD/VA Metro Locations Full/Part Time: Full-Time Posting Open-Close 01/14/2026 - 01/30/2026 Union NRP ... from you. **What You'll Bring:** + Proven experience in IT asset lifecycle management + Strong understanding of licensing, compliance, and vendor management +… more
- Washington Metropolitan Area Transit Authority (Washington, DC)
- …of the capital programming process Interested candidates should have proven management experience and the ability to communicate at an executive-level. Candidates ... would benefit from experience in program management and/or project management and should be able to analyze complex projects and/or have experience using… more
- American Bankers Association (Washington, DC)
- …national significance equals a winning combination! Click Here to review ABA's holistic approach to Benefits and Total Rewards. ... the Chief Finance & Administration Officer (CFAO), shaping financial strategy, risk management , and investment decisions while leading a team of eleven responsible… more
- AmeriHealth Caritas (Washington, DC)
- …meet the patient's needs in the least restrictive and most effective manner. The Utilization Management Reviewer must maintain a strong working knowledge of ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity...cases are escalated to the Medical Director for further review . The reviewer independently applies medical and… more
- Humana (Annapolis, MD)
- …analysis and integrated care needs for those with autism + Prior experience with Utilization Review , Utilization Management , Peer Reviews and/or Quality ... caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes...appropriate treatment, care, or services for ACD participants. + Review ABA TPs for policy compliance + Review… more
- Humana (Annapolis, MD)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Washington, DC)
- …**Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview ... our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... of business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement, change adoption… more
- Evolent (Washington, DC)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Highmark Health (Washington, DC)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Evolent (Washington, DC)
- …responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under the auspices ... with the Director of UM to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory of the United States. +… more
- Evolent (Washington, DC)
- …Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse, Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures ... within the Utilization Management (UM) program to maximize efficiency, ensure compliance and optimize patient care and safety. This position supports … more
- CareFirst (Baltimore, MD)
- …will play a pivotal role in the modernization and redesign of the utilization management department within the Health Services division. The Sr. Business ... support initiatives in the changing healthcare industry. Using a deep understanding of utilization management , the Senor Business Consultant acts as a liaison… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... to non-network providers to TRICARE Service Center for medical necessity/appropriateness review . + Routinely monitors referral management voicemail to ensure… more
- Evolent (Washington, DC)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
