• RN / Nurse Utilization

    Elevance Health (Washington, DC)
    RN Utilization Review Nurse (Washington DC Medicaid) JR149756 **Location** : This role requires associates to be in-office 4 days per week, Monday - ... located at 609 H. Street NE. The **Medical Management Nurse ** is responsible for review of the...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
    Elevance Health (06/04/25)
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  • Utilization Management Review

    AmeriHealth Caritas (Washington, DC)
    …Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred. + A Registered Nurse ( RN ) license in the District of Columbia in ... efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination,… more
    AmeriHealth Caritas (06/03/25)
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  • Registered Nurse Case Manager

    The Arora Group (Bethesda, MD)
    Registered Nurse Case Manager Nurse Currently recruiting a Registered Nurse ( RN ) Case Manager to work the Directorate of Healthcare Operations ... be provided one month in advance. DUTIES OF THE REGISTERED NURSE CASE MANAGER ( RN ):...cost diagnoses. + Independently perform difficult and complex assessment, review , coordination, planning, monitoring, evaluation and analysis of cases.… more
    The Arora Group (03/27/25)
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  • Dialysis Clinical Manager Registered

    Fresenius Medical Center (Hyattsville, MD)
    …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
    Fresenius Medical Center (06/06/25)
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  • Clinical Registered Nurse - Remote

    Sharecare (Washington, DC)
    …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
    Sharecare (05/10/25)
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  • Registered Nurse (Non-Practicing)…

    Ivyhill Technologies LLC (Bethesda, MD)
    …referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of ... of Specialty Care Referrals, sustaining up-to-date Specialty Clinic Referral Review tools and booking guidance, complying with Referral and...RM Team. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an… more
    Ivyhill Technologies LLC (03/11/25)
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  • Utilization Management Nurse

    Humana (Washington, DC)
    …your skills to make an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse ( RN ) in the (appropriate state) with no ... of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent… more
    Humana (06/05/25)
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  • Transplant Care Nurse RN - Stem…

    Highmark Health (Washington, DC)
    …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
    Highmark Health (04/25/25)
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  • RN Hospice Case Manager (Home Health-Based)

    Amergis (Columbia, MD)
    Salary: $53 / Hour The Registered Nurse - Hospice Case Manager is responsible for providing care, comfort and supportto terminally ill patients. The Registered ... the delivery of hospice patient carein various settings. The Registered Nurse demonstrates the abilityto make clinical...in the managementof patient care. Position Details: + Position: RN Hospice Case Manager (Home Health- Based) + Location:… more
    Amergis (06/05/25)
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  • Referral Management ( RN ) Traning Manager…

    Ivyhill Technologies LLC (Bethesda, MD)
    Nurse and the the RM Reviewers. Requirements Qualified candidate must be a Licensed Registered Nurse ( RN ), with an unencumbered active RN license ... Ivyhill is currently seeking to hire Referral Management ( RN ) Training Manager to support its contract with...all incoming RM staff to be able to accurately review referrals utilizing the Specialty Referral Guideline (SRG) compliance… more
    Ivyhill Technologies LLC (03/11/25)
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