- Humana (Washington, DC)
- …part of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and ... receives guidance where needed. Follows established guidelines and procedures. The SNF Utilization Management Nurse uses clinical knowledge, communication… more
- CVS Health (Washington, DC)
- …Must be willing and able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work schedules will include weekend/holiday ... zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required +...+ Managed Care experience + Discharge planning experience + Utilization Management experience **Education** Associates Degree or… more
- 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
- 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
- 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