- CVS Health (Washington, DC)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Cognizant (Washington, DC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … more
- CVS Health (Washington, DC)
- … (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all ... and state regulated turn-around times. This includes reviewing written clinical records. **Key Responsibilities of the UM Nurse...practice experience as an RN required. + 2+ Years Utilization Management experience. + Must be willing… more
- CVS Health (Washington, DC)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- AmeriHealth Caritas (Washington, DC)
- …SIGN ON BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Evolent (Washington, DC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Washington, DC)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Erickson Living (Springfield, VA)
- …meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee + ... by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical...and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice.… more
- Elevance Health (Washington, DC)
- **Medical Management Nurse ** **Location:** Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and ... adaptable workplace. Alternate locations may be considered. The **Medical Management Nurse ** will be responsible for review... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience;… more
- CVS Health (Washington, DC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The Registered Nurse - Accreditation Coordinator provides fundamental, knowledge-based care while developing technical skills on this assigned unit where ... duties/functions include, but are not limited to: The Accreditation Coordinator Nurse provides fundamental, knowledge-based care while developing technical skills on… more
- Trinity Health (Germantown, MD)
- …Opportunities to advance within the organization **Description:** The Nurse in Charge/ Nurse Supervisor (NIC) is a designated clinical leader for a patient ... Type:** Full time **Shift:** 12 Hour Day Shift **Description:** **Job Title:** Nurse In Charge / Nurse Supervisor **Unit:** Acute Care/Med/Tele **Employment… more
- Highmark Health (Washington, DC)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… 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
- Trinity Health (Silver Spring, MD)
- …needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical workflows to ensure optimal outcomes and regulatory ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Clinical Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment… more
- Trinity Health (Silver Spring, MD)
- …Advancement Program + **Location:** Holy Cross Health, Silver Spring, MD **Description:** The Nurse Supervisor is a designated clinical leader for a patient care ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Nurse Supervisor- IMC **Employment** **Type:** Full time / Day Shift… more
- Elevance Health (Ashburn, VA)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:**… more
- Evolent (Washington, DC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Trinity Health (Silver Spring, MD)
- …Day 1 Benefits, 10k Sign-on Bonus & More** As a Home Health Registered Nurse , you'll provide in-home skilled nursing care to patients by developing personalized care ... this role offers a rewarding opportunity to apply your clinical expertise in a more independent, patient-focused environment. **Why...savings that make a difference. + **Supportive Leadership** Our management team is here to help you succeed every… more
- Elevance Health (Washington, DC)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... **Pediatric Nurse Case Manager Sr** **Location:** Washington, DC. This... Case Manager Sr** will be responsible for care management within the scope of licensure for members with… more