- Office of the Secretary of Defense (Arlington, VA)
- …systems with program initiatives and utilizes advanced technology for effective data management , ensuring the department remains at the forefront of financial ... management practices. Provide expert advice, oversee budget policy, and...oversee budget policy, and recommend efficient and effective fund utilization strategies. Develop and managing long-term budget plans and… more
- AHU Technologies, Inc. (Washington, DC)
- …and Responsibilities The resource performs background investigations that includes the review of documents, and financial data to determine the applicants' ... activities. 6. Prepares clear and comprehensive investigative reports. 7. Performs effective utilization of the Microsoft Office Suite for tasks such as data entry… more
- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Humana (Annapolis, MD)
- …MDS Coordinator or discharge planner in an acute care setting + Previous experience in utilization management / utilization review for a health plan or ... of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Cognizant (Washington, DC)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- Evolent (Washington, DC)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Washington, DC)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Koniag Government Services (Germantown, MD)
- …weapons design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons to review and assess documents. ... Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company is seeking an entry-level Document Reviewer Level 1 (DRL1) to conduct classification reviews of government agency… more
- Evolent (Washington, DC)
- …match reviewer for Spine Surgery cases. you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Elevance Health (Washington, DC)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 3 (DRL3) to conduct classification reviews in accordance with… more
- Evolent (Washington, DC)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… 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 ... to non-network providers to TRICARE Service Center for medical necessity/appropriateness review . + Routinely monitors referral management voicemail to ensure… more
- Koniag Government Services (Germantown, MD)
- …Services, LLC,** a Koniag Government Services company, is seeking a Lead Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our ... design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons. **Essential Functions, Responsibilities & Duties… more
- Trinity Health (Silver Spring, MD)
- …of hospitalization, LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities, resource ... Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. **5.** Revenue… more
- Evolent (Washington, DC)
- …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Washington, DC)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
