- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... Preferred **Experience:** 5 years Clinical nursing experience. 2 years Care Management and/or Utilization Management . **Preferred Qualifications:** + … more
- CareFirst (Baltimore, MD)
- …care. + Reviews the performance of provider partners based on utilization , trends, and quality metrics to develop rate/reimbursement solutions. Ensures that ... geographically competitive, offers broad access, and meets cost and trend management objectives. **Regulatory and Healthcare Landscape** + Monitors and remains… more