- 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
- CVS Health (Annapolis, MD)
- …licenses + Ability to work rotating weekends **Preferred Qualifications** + Managed care/ utilization review experience preferred + Acute care experience + ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- CVS Health (Annapolis, MD)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
- Humana (Washington, DC)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more
- Sharecare (Washington, DC)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... referral management services for beneficiaries in the Defense Health Network. Registered Nurse will have overall responsibility for timely review of Right of… more
- Prime Therapeutics (Washington, DC)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + ... drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral… more
- BAYADA Home Health Care (Falls Church, VA)
- …operations. This individual will be responsible for overseeing the day-to-day management of the agency, ensuring high-quality patient care, regulatory compliance, ... metrics including admission rates, re-hospitalizations, visit productivity, and clinician utilization . + Collaborate with referral sources, physicians, hospitals, and… more
- Fresenius Medical Center (Hyattsville, MD)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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 ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… more