- 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
- LifePoint Health (Warrenton, VA)
- …Work Experience* *Required*- Three years of nursing experience. *Preferred*- Experience in utilization review , case management , discharge planning, and ... and other members of the healthcare team to ensure proper case management and effective discharge planning. . Monitors patient and family satisfaction. Responds… 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
- 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
- Architect of the Capitol (Washington, DC)
- …Chief Operating Officer, Superintendent, House Office Buildings (HOB) is seeking a Management and Program Analyst who will provide support to the Superintendent and ... operations. This role focuses on workforce and program analysis, records management and providing employee relations advisory services to staff. Responsibilities The… more
- Erickson Living (Springfield, VA)
- …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
- CommuniCare Health Services Corporate (Martinsburg, WV)
- … + Weekly visits to facilities for intervention, audit and training + Review resident clinical records for coverage, utilization , errors, assessments and ... RN Mobile MDS Coordinator, Registered Nurse CommuniCare Health Services is currently looking...experience with Federal Medicare/Medicaid and Managed Care reimbursement system management in working with the MDS and RAI process… 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 (Fairfax, VA)
- …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
- 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
- Architect of the Capitol (Washington, DC)
- …management operations, timber management , wildland fire science or fire management , utilization of forest resources, forest regulation, recreational land ... possess and maintain a valid state driver's license. Arboretum Management - (Duties quoted below are at the GS-13...of General Schedule Positions. It is available for your review on the OPM web site at http://www.opm.gov/qualifications. In… more
- Lincoln Financial (Washington, DC)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like ... this role you will provide coaching and guidance to claims regarding medical management **What you'll be doing** * Evaluate medical information to clarify diagnoses,… more
- PNC (Herndon, VA)
- …internal business partners in a timely manner. Effectively executes on contact management strategy through utilization of available tools and resources including ... Regularly meets with internal business partners to communicate and review business results and pipeline management .May drive...the Federal Deposit Insurance Act (FDIA) and, for any registered role, the Secure and Fair Enforcement for Mortgage… 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 in one… more