- CVS Health (Annapolis, MD)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST zones.… more
- CVS Health (Annapolis, MD)
- …Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Humana (Annapolis, MD)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- 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
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Part-time. Monday-Friday, 8:00AM-4:30PM. + **Facility:** St. Agnes Hospital + **Location:** ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Ivyhill is currently seeking to hire Referral Management (RN) Training Manager to support its contract...all the duties and requirements of the Referral Registered Nurse and the the RM Reviewers. Requirements Qualified candidate… more
- 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
- 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 ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its contract with the Integrated Referral Management and… more
- Evolent (Annapolis, MD)
- …Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...**Qualifications:** + Current, unrestricted state licensure as a Registered Nurse + Associate or Bachelors in Nursing … more
- Humana (Annapolis, MD)
- …course of action. **Key Functions:** + Serves as a liaison between Humana utilization management (UM) operations, Humana's Risk and Compliance lines of defense, ... regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. + Develop and implement … more
- CVS Health (Annapolis, MD)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Specialty Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- CVS Health (Annapolis, MD)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation… more
- Humana (Annapolis, MD)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Highmark Health (Annapolis, MD)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- University of Maryland, Baltimore (Baltimore, MD)
- …managed by University of Maryland Medical Center (UMMC). 8. Provides oversight of utilization and risk management activities including monitoring of service ... capacity, ADC 10-15. located in Towson, MD * Staffed with 24 /7 and Neonatal Nurse Practitioners * TeleHealth Support 24/7 from the UMMC Level IV NICU * The Maryland… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …licensed vocational nurses/ nursing assistants as appropriate to the setting. The nurse has advanced knowledge and skills in assessing, inserting, caring for, and ... The nurse will assist in directing the provision of nursing education, orientation, competencies and providing quality improvement and outcomes utilization… more
- Sedgwick (Annapolis, MD)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... lines; and to provide expertise in client specific case management and utilization review requirements and ensure...territory of the United States required. Certification in case management required. Bachelor's degree in nursing (BSN)… more
- Sharecare (Annapolis, MD)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse...Hours are on Central Standard Time. _ A compact nursing license is required for this position_ **Essential Job… more
- Genesis Healthcare (Bowie, MD)
- …is required. *Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable. *Must ... and state regulations. *Manage all Medicare/Medicaid case-mix documents at the nursing center to assure appropriate reimbursement for services provided. This will… more