- CVS Health (Washington, DC)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST and CST zones.… more
- 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...Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse (RN) license in the District of Columbia in… more
- Elevance Health (Washington, DC)
- …and adaptable workplace. The office is located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the most complex or challenging ... RN Utilization Review Nurse (Washington DC Medicaid)...the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred.… more
- Humana (Washington, DC)
- …a part of our caring community and help us put health first** The Utilization Management (UM) Director, Clinical Strategy and Practice for Medicaid builds ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director, Clinical Strategy and Practice for… more
- The Arora Group (Bethesda, MD)
- …Certified Care Managers: Care Manager Certified (CMC) + Experience: + Referral Management / Utilization Management (RM/UM) experience. + Clinical subspecialty ... case-managed patients, throughout the continuum of care. + Conduct training in nurse case management for professional and paraprofessionals personnel, within the… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …Washington DC VA Medical Center Post-Acute Rehabilitation and Long Term Care Registered Nurse registered nurse provides care and counseling of persons of health ... Responsibilities The Post-Acute Rehabilitation/Polytrauma and Long Term Care (LTC) Registered Nurse (RN) provides care and counseling of persons or in the… 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 ... the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a...and regulations. * Practices and maintains the principles of utilization management and appeals management … more
- Johns Hopkins University (Columbia, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for ... to obtain informed consent from study participants. + Remain proficient in the utilization of commonly used clinical protocols and guidelines. + Remain abreast of… 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
- 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 a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center… more
- Trinity Health (Silver Spring, MD)
- …high-quality care to patients with complex renal needs. As the designated Nurse Supervisor, you'll coordinate staffing, resource management , and clinical ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Nurse Supervisor - Dialysis** **Location: Holy Cross Hospital** **Employment Type: Full Time**… more
- HCA Healthcare (Fairfax, VA)
- …you passionate about delivering patient-centered care?** Submit your application for Operating Room Nurse Float Pool position and spend more time at the bedside with ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Surgery Ventures! **Job Summary… more
- Koniag Government Services (Camp Springs, MD)
- Occupational Health Registered Nurse Camp Springs, MD, USA Req #280 Wednesday, April 30, 2025 **Koniag Professional Services, LLC,** a Koniag Government Services ... company, is seeking a full time Occupational Health Registered Nurse to support **KPS** and our government customer in Camp Springs, MD. **_This position is for a… more
- Highmark Health (Washington, DC)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- Elevance Health (Hanover, MD)
- …required.** The **Telephonic Nurse Case Manager I** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager I** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum** **Requirements:**… 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 to ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… 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 ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… 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 (Lanham, MD)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... by working with the Vice President of Quality and other organization management to ensure that organization/ASC policies and procedures are followed. + Responsible… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its contract with the Integrated Referral Management and… more