- Greater Baltimore Medical Center Healthcare (Towson, MD)
- …*Must possess current Maryland State license as a Registered Nurse . *Certification as CPR instructor by American Heart Association preferred ... throughout the program *Collaborate with stakeholders for ongoing evaluation of nurse graduate placement to ensure appropriateness *Assist new graduates in… more
- Small Door Veterinary (Washington, DC)
- …status - meaning we abide by strict standards! What you'll do People Management and Leadership Manage, develop, and lead a high-performing team in providing ... Lead team meetings in collaboration with the Managing Veterinarian and Managing Nurse , ensuring relevant information sharing Uphold a culture of safety, compliance,… more
- Children's National Hospital (Washington, DC)
- …Nurse in District of Columbia (Required) Current certification in Case Management or Utilization Management (Preferred) Functional Accountabilities ... The Case Manager Hybrid I/II will provide case management services to patients and their families or...Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and… 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)
- …the offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review . ... **Details** + **Department:** Utilization Management + **Schedule:** Part-time. Monday-Friday,...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience.… more
- Humana (Annapolis, MD)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more
- Sharecare (Annapolis, MD)
- …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...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for ... support in response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine differential diagnosis. +… more
- Fresenius Medical Center (Hyattsville, MD)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Fresenius Medical Center (Baltimore, 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
- 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...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… 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...as a resource for the nurses to conduct concurrent review for medical necessity and appropriate level of care… more
- GetWellNetwork, Inc. (Washington, DC)
- …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Well's Client Service Manager is responsible for effective product utilization and successful outcomes for the Get Well system...of the Get Well system by conducting quarterly account review meetings pertaining to account roadmap; conduct nurse… more
- Trinity Health (Silver Spring, MD)
- …experience in the development and management of quality, risk, and utilization review processes. + Strong leadership, communication, and analytical skills. + ... a high level of patient satisfaction and effective resource utilization . + Collaborate with certified nurse midwives,...deliver comprehensive care. + Participate in quality, risk, and utilization review processes. + Supervise and teach… more
- CVS Health (Annapolis, MD)
- …Shift will be different once training is completed.) As a Care Management Associate you will be supporting comprehensive coordination of medical services including ... and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare… more
- Highmark Health (Annapolis, MD)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- University of Maryland, Baltimore (Baltimore, MD)
- …related to the delivery of medical care and clinical services such utilization review , quality assurance, policies, procedures and guidelines development. 3. ... Towson, MD * Staffed with 24 /7 and Neonatal Nurse Practitioners * TeleHealth Support 24/7 from the UMMC...of Maryland Medical Center (UMMC). 8. Provides oversight of utilization and risk management activities including monitoring… more
