- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- The Arora Group (Bethesda, MD)
- …Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty ... Registered Nurse Case Manager Nurse Currently recruiting a...guidelines to include, the following: + Provide professional case management services at Walter Reed National Military Medical Center… 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. ... Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of First Refusal (ROFR) requests, review of Specialty… more
- Sharecare (Washington, DC)
- …total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised… more
- Veterans Affairs, Veterans Health Administration (Baltimore, MD)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities Duties: Critical Care Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned patients and oversight of… 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
- 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...(MCG) to act as a resource to conduct concurrent review for medical necessity and appropriate level of care… more
- Immigration and Customs Enforcement (Washington, DC)
- …Service Corps (IHSC). The incumbent will report directly to the Medical Case Management Program Manager (MCMPM). This is a non-supervisory position. This position is ... communicating with RCDs for community referrals. Collaborate with Health Plan Management Unit for all hospitalization concurrent visits monitoring. Utilize unified… 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. ... Ivyhill is currently seeking to hire Referral Management (RN) Training Manager to support its contract...all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance… more
- Treasury, Departmental Offices (Washington, DC)
- …and utilization of workforce statistics, HR IT solutions, project management and process improvement techniques. - working with data to identify data ... Department of the Treasury in Washington, DC. As a Management and Program Analyst, you will be an expert...be required to comply with federal ethics laws. A review of financial or other interests may be conducted… more
- Erickson Living (Parkville, MD)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... clinical practice and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice. + Ownership of… more
- CareFirst (Baltimore, MD)
- …of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals. ... members for government programs lines of business. Ensures quality management of the clinical appeal process to reduce the...with dynamic goals resulting in the full and fair review of appeals and grievances designed to achieve corporate… more
- Teleflex (Frederick, MD)
- …corrective action is taken and that customers are properly notified. * Keep management informed of competitors' activities through review of information from ... today, from our world-class brands including: + LMA(R) and Rusch(R) airway management devices designed to help reduce the risk of airway-related complications. +… more
- Immigration and Customs Enforcement (Washington, DC)
- …(Nurse Practitioner/Physician Assistant), preferably in correctional or detention setting. Case management and utilization review experience preferred. ... AOR and formally reports site visit findings to ICE/ERO and IHSC for review and approval of medical compliance findings related to ICE National Detention Standards… more
- Sunrise Senior Living (Arlington, VA)
- …discounts at higher education institutions * Higher wage rates * Changes in management * Improved health and wellness benefits starting January 2025 The Director of ... Nursing is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning,...the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team… more
- Sunrise Senior Living (Bowie, MD)
- …The Director of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning, organizing and ... position. Clinical Care Delivery Operations + Directs, supervises the management of the team members in the skilled nursing...the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team… more
- Customs and Border Protection (Washington, DC)
- …Accountability, and Evaluation Division; International Engagement and Incident Management Division; Trade Intelligence Division, and Trade Investigations Division. ... procedures and regulations, utility, technical adequacy, timeliness and effective utilization of resources. Identifying operating problems, conflicting priorities, program… more
- Architect of the Capitol (Washington, DC)
- …availability of adequate resources consistent with project objectives; Assisting with the management of the utilization of resources, justifies plans and ... the Capitol (AOC), Office of the Chief Engineer, Project Management Division is seeking an exceptional General Engineer or...of General Schedule Positions. It is available for your review on the OPM web site at OPM qualification… more