- Quadrant Inc (Washington, DC)
- Licensed Practical Nurse Washington, DC Pay From : $30 per... of patient care between visits Assists in the management of patient utilization of health care ... hour MUST: The Licensed Practical Nurse must have experience: Licensed Practical Nurse license in the District of Columbia BLS certified Strong diagnostic and… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Washington, DC)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Washington, DC)
- …clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and applies… 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, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Sharecare (Washington, DC)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- Summary The Intravenous Therapy Registered Nurse is responsible for providing competent, evidence-based care to assigned patients and oversight of licensed ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Responsibilities The primary purpose of the Intravenous… more
- Battelle Memorial Institute (Arlington, VA)
- …as a case manager by a recognized certifying organization, ie, Commission for Case Management Certification or American Nurse Credentialing Center + At least two ... Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer,… more
- Elevance Health (Washington, DC)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Virtual:** This role enables associates...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Erickson Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review, and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee ... by Erickson Senior Living Join our team as the Nurse Manager, RN also known as the Clinical Manager!...and processes in accordance with the Erickson Senior Living Management Policies and Procedures and nursing standards of practice.… more
- Elevance Health (Washington, DC)
- **Medical Management Nurse ** **Location:** Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and ... a dynamic and adaptable workplace. Alternate locations may be considered. The **Medical Management Nurse ** will be responsible for review of the most complex… more
- Evolent (Washington, DC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- Elevance Health (Washington, DC)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... **Pediatric Nurse Case Manager Sr** **Location:** Washington, DC. This... Case Manager Sr** will be responsible for care management within the scope of licensure for members with… more
- Select Medical (Alexandria, VA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (Alexandria, VA)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- BrightSpring Health Services (Arlington, VA)
- … utilization and hospital admission reduction. + Provides survey management support/ follow-up/and coordination of corrective actions plans relatied to care ... and direction in performance improvement, provision of clinical services, survey management , documentation management , incident management , EMR/EHR… more
- Sharecare (Washington, DC)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- ZOLL Medical Corporation (Washington, DC)
- …patients suffering from serious cardiopulmonary and respiratory conditions.ZOLL Cardiac Management Solutions offers a unique portfolio of novel technologies designed ... patients at risk of sudden cardiac death. + HFMS (https://cardiacdiagnostics.zoll.com/products/heart-failure-arrhythmia- management -system/) (Heart Failure Management system) is a… more
- Sunrise Senior Living (Fort Belvoir, VA)
- …per state regulations + A minimum of two (2) years' experience in a nurse management position within a skilled nursing environment including hiring staff, ... of Nursing Services is responsible for providing leadership and management to the skilled nursing operations. Responsible for planning,...highest quality standards for well being. + Ensures proper utilization of the Resident Care Plan by all team… more
- Howard University Hospital (Washington, DC)
- …placement of admitted patients. The incumbent assists in the formulation of a nurse float pool and coordinates the daily use of supplement staff. The incumbent ... Clinical Nursing Administrator : Provides leadership, coordination and management of personnel, and assumes responsibility for hospital administrative functions… more
