- Luminis Health (Lanham, MD)
- …Duties: 1. Chart Review : Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization ; ... Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization... : Monitors and identifies patterns or trends in utilization management ; monitors potential and actual denials… more
- Humana Inc (Washington, DC)
- … management Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Luminis Health (Lanham, MD)
- …to the unit at education/staff development functions as well as designated management functions to promote high quality, cost effective health care. This position ... to hiring, evaluating performance, issuing final disciplinary actions under the review of Human Resources, and recommending discharge in collaboration with members… more
- Hispanic Alliance for Career Enhancement (Washington, DC)
- …plans, fraud, waste and abuse in Medicare, prior authorization processes and utilization management in Medicare, and telehealth policies. Additional experience ... and BCBS Plan objectives at both state and federal levels. Manages the review of legislation and regulations to identify and provide feedback to policymakers and… more
- Children's National Medical Center (Washington, DC)
- …Maintain a file system documenting all project initiatives and ongoing utilization . Technology Management Collaborate with all departments to understand ... planning for projects, project coordination, equipment evaluation, medical equipment management program development and maintenance system management , and… more
- Humana Inc (Annapolis, MD)
- …management . Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge… more
- Chrysalis House, Inc. (Crownsville, MD)
- …with leadership to provide and evaluate data for quality standards and utilization measurements. Essential Duties: Management and oversight of clinical and ... and protocols to support clinical and other residential services. Conducts annual review and revision of clinical policies and procedure manuals. Develops and… more
- Contact Discovery Services, LLC (Baltimore, MD)
- …communication, issue resolution, and continuous improvement. Generate monthly report metrics for utilization and data management . Serve as a subject matter ... managed service offerings. Prepare and lead client meetings to review reporting metrics, platform usage, and overall service experience...expert in the Relativity document review platform, with mastery across the full lifecycle, from… more
- American Public Power Association (Washington, DC)
- …on issues of national significance equals a winning combination! Click Here to review ABA's holistic approach to Benefits and Total Rewards. Employer of Choice: ABA ... the Chief Finance & Administration Officer (CFAO), shaping financial strategy, risk management , and investment decisions while leading a team of eleven responsible… more
- The Fairness Project (Washington, DC)
- …and excellent donor engagement. Drive fundraising best practices, including systems utilization , prospecting, donor reporting, data review , and donor ... of fundraising best practices; demonstrated success building processes and donor management systems to track and steward funders. Experience building strong… more
- Grossman Solutions (Washington, DC)
- …content for fundraising materials Drive fundraising best practices, including systems utilization , research and prospecting, donor reporting, data review , and ... and implementing a robust development strategy, building processes and donor management systems to steward funders, and establishing and strengthening relationships… more
- Grossman Solutions (Washington, DC)
- …and excellent donor engagement. Drive fundraising best practices, including systems utilization , prospecting, donor reporting, data review , and donor ... of fundraising best practices; demonstrated success building processes and donor management systems to track and steward funders. Experience building strong… more
- Leidos (Bethesda, MD)
- …Design of components and prototypes Design of test plans and test assemblies Utilization of SolidWorks to create models and drawings of concepts and products ... Utilization of FEA software like Ansys to perform analysis...BOM, rationale, methods of manufacturing, procedures, etc.) Support Failure Review Board and Material Review Board Activities… more
- The US Pharmacopeial Convention (USP) (Rockville, MD)
- …trusted advisor of client leaders. Builds the business partner relationship with management and staff. Understands the business, goals, and challenges and identifies ... appropriate. Assists managers with all aspects of the annual performance management and development process including coaching client groups on effective… more
- The US Pharmacopeial Convention (USP) (Rockville, MD)
- …responsible for critical functions including Expert Volunteer Engagement, Expert Committee Management , and Standards of Conduct Program. This position plays a ... leadership role for management of expert committee and volunteer activities, including transformation and continuous improvement of processes and policies. The… more
- Somatus - Revolutionizing Kidney Care (Mclean, VA)
- …Integrity Product Areas: Clinical Claim Review , Payment Analytics, Fraud Capture, Utilization Review . Build business cases to secure development funding. Own ... one another, and show up for our mission. Responsibilities Lead performance management tied to key metrics and business drivers that inform strategic decisions.… more
- Kappaalphapsi1911 (Baltimore, MD)
- …internal and external audits by assisting with preparation of audit schedules and review of audit results. * Supports the creation of budgets and/or forecasts in ... both financial and statistical matters in order to facilitate financial management throughout the organization; and assisting with organizing regular meetings with… more
- LightHouse Behavioral Health Center, LLC. (Baltimore, MD)
- …Approve treatment plans, assessments, and discharge planning activities Monitor utilization review and case assignments Ensure trauma-informed, culturally ... during rounds, site visits, and staff monitoring Prolonged desk work for documentation review and EHR navigation Occasional lifting of materials or supplies (up to… more
- Enterprise Mangement Solutions Inc (Baltimore, MD)
- ABOUT ENTERPRISE MANAGEMENT Enterprise Management is a full-spectrum consulting and management firm specializing in back-office operations, financial ... Chief Operations Officer ALTERNATE TITLE(S) Senior Operations Executive COMPANY Enterprise Management Solutions, Inc. (in support of all customer companies under… more
- University of Maryland Faculty Physicians, Inc. (Baltimore, MD)
- …presentations, business analyses, and recommendations for executive and board-level review . Identifies and recommends topics for policy and procedure development ... and compliance across FPI practices. Operational Leadership & Practice Management Ensures efficient, high-quality practice operations that support staff, providers,… more
