- Cognizant (Washington, DC)
- …you need to have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Humana (Annapolis, MD)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse (RN) in a compact state… more
- Humana (Washington, DC)
- …a part of our caring community and help us put health first** The Weekend Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Communities is good for the Soul. Join Us!** The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in the (appropriate state)… more
- CVS Health (Washington, DC)
- …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team.… more
- Fresenius Medical Center (Clinton, MD)
- …requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory ... FMCNA Compliance Program, and FMS patient care and administrative policies as the clinical leader, has the authority to make daily decisions to ensure continuity of… more
- Fresenius Medical Center (Towson, MD)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The primary purpose of the Registered Nurse , Same Day Patient Unit is to demonstrate leadership in delivering and improving holistic care through ... Major duties include, but are not limited to: The Registered Nurse (RN) is responsible for providing...alignment with the ANA Standards of Nursing Practice. Applies clinical knowledge/judgment to lead staff involvement in planning, decision… 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 ... of any number of regulatory bodies in accordance with VHA Directive 1050.01. Registered Nurse (RN) is responsible and accountable for individual nursing practice… more
- CVS Health (Washington, DC)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Ivyhill Technologies LLC (Bethesda, MD)
- Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center ... and referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of… more
- CareFirst (Baltimore, MD)
- …required in addition to the required work experience. **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization...Hire Required + CNS- Clinical Nurse … more
- Humana (Annapolis, MD)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CareFirst (Baltimore, MD)
- …Office programs. **Licenses/Certifications Required Upon Hire** : Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure. ... approved claims. + Prepares retrospective reviews, case appeals, billing coordination, and clinical support. + Manages the analysis of utilization patterns, such… more
- Trinity Health (Silver Spring, MD)
- …Overview - 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 ... this role offers a rewarding opportunity to apply your clinical expertise in a more independent, patient-focused environment. **Why...an approved Nursing education program, BSN preferred. + Current Registered Nurse licensure in the state of… more
- CVS Health (Annapolis, MD)
- …Service/Health Services (as applicable to hiring program) or Associates degree with a Registered Nurse with Behavioral Health experience/ background with 3 years ... we do it all with heart, each and every day. **Position Summary** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization… more
- AmeriHealth Caritas (Washington, DC)
- …standards in a fast-paced, high-volume environment. **Licensure:** + An active and unencumbered Registered Nurse license in the District of Columbia is required. ... SIGN ON BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for… more
- CareFirst (Baltimore, MD)
- …**Education Level:** High School Diploma or GED **Licenses/Certifications:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic...**Preferred Qualifications:** + 2 years experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield,… more
- Evolent (Washington, DC)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... 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… more
- Johns Hopkins University (Baltimore, MD)
- …and rapidly changing environment. **Minimum Qualifications** + Master's Degree in Nursing. + Registered Nurse license and Certified as a Nurse Practitioner. ... guidelines of the department and institution and in accordance with the Nurse Practitioner-Physician Written Agreement required and approved by the State of Maryland… more
- Johns Hopkins University (Baltimore, MD)
- …team while maintaining patient confidentiality. **Minimum Qualifications** + Master's Degree in Nursing; Registered Nurse license and Certified as a Nurse ... to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast… more