- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… 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, ... impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth...in a fast-paced environment. The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- Zurich NA (Washington, DC)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
- Elevance Health (Fairfax, VA)
- …of licensure the District of Columbia is required. **Preferred Qualifications:** + Utilization Management /Review in managed care strongly preferred. + Inpatient ... RN Utilization Review Nurse (Washington DC Medicaid) JR149756 **Location**...is located at 609 H. Street NE. The **Medical Management Nurse** is responsible for review of the most… more
- Trinity Health (Silver Spring, MD)
- …review, or similar areas. + Extensive understanding of payer mechanisms and clinical utilization management . + Strong interpersonal skills with a track record of ... **Employment Type:** Full time **Shift:** **Description:** **Position Title:** Director , Multi- Complex Acute Care Management **Job Type** : Exempt- Full Time… more
- Trinity Health (Silver Spring, MD)
- … review, or a similar area. + Strong knowledge of payer mechanisms, utilization management , and regulatory requirements. + Proven ability to lead through ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** Director of Care Management ** **Holy Cross... develops, organizes, and leads an integrated, hospital-wide care management program to optimize resource utilization , care… more
- Humana (Washington, DC)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Washington, DC)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Washington, DC)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Washington, DC)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
- Genesis Healthcare (Kensington, MD)
- …Area Director ). 11. Assumes responsibility for daily staffing and utilization with input from treating therapists, consideration of clinical requirements, and ... management of the rehab department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient… more
- Humana (Washington, DC)
- …Medical Director , depending on size of team or line of business. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Washington, DC)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
- Evolent (Washington, DC)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National … more
- United Therapeutics (Washington, DC)
- …is innovative and inspiring where you can truly make a difference. The Regional Field Director , RNS Program Management serves as a director of all clinical ... the commercial non-promotional team. In addition, the Regional Field Director , RNS Program Management will: + Serve...initiation of a UT product, adverse effect mitigation, device utilization , and dosing upon request + Support the Clinical… more
- PenFed Credit Union (Mclean, VA)
- …it's about being a part of the PenFed family. PenFed is hiring a (Hybrid) Director , IT Management Controls at our Tysons, Virginia location. The primary purpose ... and generalists to generally promote and provide strong governance and management practices across PenFed's IT Division. This position directly supports the… more
- Grant Thornton (Arlington, VA)
- …to share strategy, to implement process improvements and to roll out capacity management strategies to maximize utilization and drive operational excellence + ... Grant Thornton is seeking an Advisory Capacity & Resource Management (C&RM) Leader to join the team. Approved office...on yearly budget planning for headcount, gross charge hours, utilization , and leverage. You will lead your team to… more
- ICF (Reston, VA)
- Description **PROJECT DIRECTOR , Grants Management ** ICF seeks a motivated and experienced Project Director to manage a large government contract that ... on a national level. + Knowledge of federal grants financial management statutes, regulations and policy. + This position requires a deep understanding of… more
- EAB (Washington, DC)
- …recent awards. For more information, visit our Careers page. The Role in Brief: Associate Director , K-12 Account Management + Do you want to make a difference in ... for finding solutions in complex or difficult situations? The Associate Director is responsible for developing and maintaining relationships with K-12 institutions… more