- Elevance Health (Shepherdstown, WV)
- RN Utilization Management / Review Nurse - InPatient Medicaid (JR155056) **Location:** This position requires you to **reside in the state of West ... Friday, 8am - 5pm The **Medical Management Nurse ** (Medicaid Utilization Review ) is...an equivalent background. + Current active, valid and unrestricted RN license to practice as a health professional within… more
- AmeriHealth Caritas (Washington, DC)
- …Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse ( RN ) license in the District of Columbia in ... Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- The Arora Group (Bethesda, MD)
- Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager to work the Directorate of Healthcare Operations ... be provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ):...Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. +… 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
- Sharecare (Washington, DC)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations...orientation and to take the pre and posttests to review competency during orientation. Yearly competency test is required… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of First ... RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- Veterans Affairs, Veterans Health Administration (Martinsburg, WV)
- … review of the EDRP application Responsibilities Inpatient Mental Health (MH) Registered Nurse ( RN ) provides competent, evidence-based care, the ... nurse independently provides patient-centered and recovery-oriented care, milieu management , and maintains self-awareness while caring for patients living with… more
- Highmark Health (Washington, DC)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective ** utilization management ** strategies including: review of appropriateness ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management , you will be the key...care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of… more
- Ivyhill Technologies LLC (Bethesda, MD)
- … Nurse and the the RM Reviewers. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire Referral Management ( RN ) Training Manager to support...have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management … more
- CommuniCare Health Services Corporate (Martinsburg, WV)
- RN Mobile MDS Coordinator, Registered Nurse CommuniCare Health Services is currently looking to fill the key position of Mobile MDS Coordinator, RN for ... successful candidate for the position must have a valid RN license in West Virginia, as well as previous...visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization ,… more
- Erickson Living (Springfield, VA)
- …clinical leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management /Safety ... and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice....care, assisted living or hospital) is required. + Current Registered Nurse license for the state in… more
- Sedgwick (Washington, DC)
- …satisfaction; to ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple ... business lines; and to provide expertise in client specific case management and utilization review requirements and ensure customer satisfaction through the… more
- Immigration and Customs Enforcement (Washington, DC)
- … Practitioner/Physician Assistant), preferably in correctional or detention setting. Case management and utilization review experience preferred. ... reports site visit findings to ICE/ERO and IHSC for review and approval of medical compliance findings related to...care with extensive direct patient care experience as a registered nurse or advanced practice provider (… more
- Sunrise Senior Living (Arlington, VA)
- …of approved college / school of nursing + Maintains a current state license as a Registered Nurse per state regulations. + A minimum of two (2) years' experience ... the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team...in a nurse management position within a skilled nursing… more
- Sunrise Senior Living (Fairfax, VA)
- …of approved college / school of nursing + Maintains a current state license as a Registered Nurse per state regulations. + A minimum of two (2) years' experience ... the highest quality standards for well-being. + Ensures proper utilization of the Resident Care Plan by all team...in a nurse management position within a skilled nursing… more
- Immigration and Customs Enforcement (Washington, DC)
- …extended periods of time. Education REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES: Must be a Registered Nurse , Advanced Practice Registered Nurse or ... 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… more
- KBR (Arlington, VA)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... risk management issues in order to improve practice, and ensure...; full , active, and unrestricted license as a Registered Nurse or Licensed Clinical Social Worker… more
- KBR (Washington, DC)
- …compliance in meeting care goals. + Knowledge and skill in using pre-established utilization review criteria recognize and report actual or potential quality and ... of function and self-care. + Current licensure; full, active, and unrestricted license as a Registered Nurse or Licensed Clinical Social Worker in one of any US… 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 ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more