NewUtilization Review Nurse RN LifeBridge HealthUtilization Review Nurse RNBaltimore, MD$40.12–$62.19 / hourSupport: A culture of collaboration with resources like unit-based practice councils and advanced clinical education support — improving both workflow efficiency and patient outcomes and allowing you to work at the top of your license. The Utilization Review RN at Sinai Hospital works with stakeholders in the Revenue Cycle Management process and payors to ensure efficiency of utilization of resources, minimize losses and maximize reimbursement.
NewUtilization Review Nurse RN - NE LifeBridge HealthUtilization Review Nurse RN - NERandallstown, MD$40.12–$62.19 / hourAssists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel. Support: A culture of collaboration with resources like unit-based practice councils and advanced clinical education support — improving both workflow efficiency and patient outcomes and allowing you to work at the top of your license.
NewTravel Nurse RN - Utilization Review - $1,823 to $1,918 per week in Randallstown, MD TravelNurseSourceTravel Nurse RN - Utilization Review - $1,823 to $1,918 per week in Randallstown, MDRandallstown, MD$1,823–$1,918As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
NewTravel Nurse RN - Utilization Review - $1,558 to $1,653 per week in Baltimore, MD TravelNurseSourceTravel Nurse RN - Utilization Review - $1,558 to $1,653 per week in Baltimore, MDBaltimore, MD$1,558–$1,653As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
NewTravel Nurse RN - Utilization Review - $1,512 to $1,607 per week in Baltimore, MD TravelNurseSourceTravel Nurse RN - Utilization Review - $1,512 to $1,607 per week in Baltimore, MDBaltimore, MD$1,512–$1,607As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
NewTravel RN Case Manager - $1,963 per week American TravelerTravel RN Case Manager - $1,963 per weekBaltimore, MDAmerican Traveler is seeking an experienced RN Case Manager for an adult inpatient case management role at a large academic medical center, requiring active RN licensure and current inpatient case management experience. Coordinates care for a select caseload of adult patients from triage through discharge, including transition planning to post-acute settings such as nursing facilities, acute inpatient rehab, or community resources.
NewMDS Coordinator - RN Oak Crest Village by Erickson Senior LivingMDS Coordinator - RNParkville, MD$100,000–$110,000 / yearSee Erickson Senior Living Privacy Policy at https://www.ericksonseniorliving.com/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. In this vital leadership role, you'll oversee the Resident Assessment Instrument (RAI) process, ensuring accurate and timely completion of MDS assessments from scheduling through final submission to both the MDS analysis vendor and CMS.
NewTravel Nurse RN - Case Manager - $1,907 per week in Hanover, MD TravelNurseSourceTravel Nurse RN - Case Manager - $1,907 per week in Hanover, MDHanover, MD$1,907Job Title: Utilization Review Nurse Profession: Registered Nurse Specialty: Utilization Management Duration: 8 months Shift: Day Hours per Shift: 8:00 AM - 4:30 PM Experience: Minimum of 5 years RN experience with current Utilization Review experience License: Active RN License Certifications: Proficiency in InterQual criteria software systems Must-Have: - Managed care experience in utilization review for at least 1 year preferred Description: This position involves the day-to-day management of health plan members in acute care and/or rehabilitative facilities. The Utilization Review Nurse actively monitors the appropriateness of care received by plan members in various settings, including acute hospitals and rehabilitation facilities.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNBaltimore, MDAs the facility leader, you will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal disease or chronic kidney disease. We have a diverse range of employee resource groups (ERGs) to encourage employees with similar interests, goals, social and cultural backgrounds, or experiences to come together for professional and personal development, discussion, activities, and peer support.
NewCase Manager RN LifeBridge HealthCase Manager RNRandallstown, MD$40.12–$62.19 / hourSupport: A culture of collaboration with resources like unit-based practice councils and advanced clinical education support — improving both workflow efficiency and patient outcomes and allowing you to work at the top of your license. The Care Manger strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs.
Dialysis Clinical manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical manager Registered Nurse - RNBaltimore, MDOther: • Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. • Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
NewFloat Pool Manager DON (RN) Critical Care ICU Services - Relocation Offered! MedStar HealthFloat Pool Manager DON (RN) Critical Care ICU Services - Relocation Offered!Washington, DC$102,606–$196,996The Nurse Manager will oversee a versatile team that supports specialized critical care areas, partnering closely with unit leadership to ensure seamless staffing, consistent clinical excellence, and outstanding patient outcomes. This is an exciting leadership opportunity for an operationally focused manager who excels at building high-performing teams, advancing nursing practice, and supporting excellence across multiple intensive care units.
Nursing Director (RN) Surgical Cardiovasular ICU - Relocation Offered! MedStar HealthNursing Director (RN) Surgical Cardiovasular ICU - Relocation Offered!Washington, DC$120,702–$238,222This is an outstanding opportunity to lead an expert team in a fast-paced, high-acuity, high-volume environment while partnering with nationally recognized surgeons, physicians, and interdisciplinary leaders to shape the future of cardiovascular critical care. MedStar Washington Hospital Center is seeking a Nursing Director to lead our high-performing Surgical Cardiovascular Intensive Care Unit (CVICU), home to one of the region's most advanced cardiac surgery and heart failure programs.
Utilization Management Nurse Specialist Lumen Solutions Group, Inc.Utilization Management Nurse SpecialistBaltimore, MDRemoteWe are seeking an experienced Utilization Management Nurse Specialist to support care management and utilization review activities for Medicare, Medicaid, and other government healthcare programs. This role requires an independent, detail-oriented nursing professional who can effectively collaborate with interdisciplinary teams while ensuring appropriate utilization of healthcare services and adherence to clinical and regulatory requirements.
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantMD$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
RN - Utilization Management (Insurance) Recruitment Specialists, IncRN - Utilization Management (Insurance)Hanover, MDThe Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, including acute hospitals, sub-acute hospitals, and acute rehabilitation facilities. The Utilization Nurse proactively initiates discharge planning for members, including identification of post-discharge needs and coordination of post-discharge referrals/services.
Utilization Review Nurse RN Sinai Hospital of BaltimoreUtilization Review Nurse RNRandallstown, MDAssists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel. Support: A culture of collaboration with resources like unit-based practice councils and advanced clinical education support - improving both workflow efficiency and patient outcomes and allowing you to work at the top of your license.
Utilization Management Specialist System OneUtilization Management SpecialistBaltimore, MDRemoteIn this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America.
NewUtilization Review Nurse Kaiser PermanenteUtilization Review NurseKensington, MDCollaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
Spec, Utilization Management Ampcus IncorporatedSpec, Utilization ManagementBaltimore, MD$45–$48 / hourUtilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Researches and presents educational topics related to cases, disease entities, treatment modalities to interdepartmental audiences.
NewUtilization Management Reviewer AmeriHealth CaritasUtilization Management ReviewerWashington, DCRemoteMinimum of 3 years of diverse independent clinical practice experience as a Registered Nurse in outpatient surgery, Medical-Surgical, Critical Care, Skilled Nursing Facility (SNF), Rehabilitation, or Long-Term Acute Care (LTAC) settings. Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs.
Spec, Utilization Management Iconma LLCSpec, Utilization ManagementMDResponsibilities: Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
Health Services - Spec, Utilization Management MindlanceHealth Services - Spec, Utilization ManagementBaltimore, MDPURPOSE: Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
Registered Nurse Utilization Review AscensionRegistered Nurse Utilization ReviewBaltimore, Maryland$81,120–$115,939.20 / yearFull timeCoordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.
Utilization Management CoordinatorNE University of Maryland Baltimore Washington Medical CenterUtilization Management CoordinatorNEGlen Burnie, MD$40.61–$60.96 / hourExperience the highest level of appreciation at UM Baltimore Washington Medical Center - named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace in the USA for 2021! All employees are responsible for extending the mission and values of Baltimore Washington Medical Center by dedicating oneself to providing the highest quality healthcare services to the communities we serve.
Director Utilization Management MedStar Family Choice MedStar HealthDirector Utilization Management MedStar Family ChoiceWashington, DC$120,702–$238,222 / yearFull timeMaster's degree Master's degree in Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred. The Director of Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans.
Registered Nurse Utilization Review Ascension Health AllianceRegistered Nurse Utilization ReviewBaltimore, MD$81,120–$115,939.20 / yearCoordinate seamless transitions by collaborating with the healthcare team to build safe, effective discharge plans that set patients up for success long after they leave our facility. Guide complex patient journeys through expert case management and consultation, providing a roadmap for high-quality outcomes in even the most challenging clinical situations.
Utilization Management Specialist Ampcus IncorporatedUtilization Management SpecialistOwings Mills, MD$45–$51 / hourUtilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent, and retrospective reviews for authorization, appropriateness of care determination, and benefit coverage. Ability to work effectively with large amounts of confidential member data and PHI, prioritize workload, multitask, and maintain a dynamic personal organization system.
Utilization Management Director - Inpatient (Hybrid) Blue Cross and Blue Shield AssociationUtilization Management Director - Inpatient (Hybrid)Baltimore, MD$135,040–$250,668 / yearPURPOSE: The Director Utilization Management (Inpatient) provides strategic leadership of the inpatient utilization management team and is responsible for the design, assessment, implementation and outcomes of inpatient utilization management strategies using a multidisciplinary approach to enhance member engagement, improve access to quality care and the use of cost-effective health resources. Plans, directs and evaluates the full scope of utilization management services offered in collaboration with the preservice UM Director, and works closely with leadership, members, providers, vendors, accounts, and other strategic business partners.
Utilization Review RN, Care Coordination, Bethesda West, FT, 8A-4:30P-159236 Baptist Health South Florida IncUtilization Review RN, Care Coordination, Bethesda West, FT, 8A-4:30P-159236Bethesda, MDOur approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including: Career growth and development opportunities, with clear pathways and ongoing support Comprehensive health and wellness resources that go beyond traditional benefits A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs Tuition reimbursement to support continued learning and advancement And so much more Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day. Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.
Director Utilization Management MedStar Family Choice MedStar Health Research InstituteDirector Utilization Management MedStar Family ChoiceWashington, DC$120,702–$238,222 / yearMaster's degree Master's degree in Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred. The Director of Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans.
Nurse CARE Manager, Wellness Center & Case Management Marriott International IncNurse CARE Manager, Wellness Center & Case ManagementBethesda, MDThe Nurse CARE Manager provides dual support through direct clinical care at the Marriott Headquarters Wellness Center and nurse case management (NCM) services for the Eastern Region Claims Services office. Demonstrated ability to apply strong communication, organizational, and critical thinking skills to assess patient needs, solve complex problems, and manage case workflows with a high level of efficiency and attention to detail.
Utilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerBaltimore, MDRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.
Manager Case Management (Registered Nurse or Social Worker) Inova Health SystemManager Case Management (Registered Nurse or Social Worker)Falls Church, VAMust have one of the following: Accredited Case Manager (ACM) or Certified Case Manager (CCM), or MCG/UR or, Certified Clinical Transplant Social Worker (CCTSW) pr N/ASW-CM (ASWCM) or licensed as a Social Worker (LCSW) in Virginia or eligible to practice on the Commonwealth of Virginia as a Social Worker within 12 months of hire.\n \n\n \nPreferred Qualifications:\n\n Three (5) + years of previous Inpatient (hospital) case management experience, case management discharge planning, and two (2) years supervisory/lead experience is highly preferred. The new Magnet designation is in addition to several other prestigious recognitions which include: a five star rating from the Centers for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation's highest performing hospitals, and among the top 10 Major Teaching Hospitals, an A for Patient Safety by The Leapfrog Group, the #1 hospital in the DC metro area by U.S. News & World Reports, and being nationally ranked in gynecologic care\n \nThe Manager of Case Management participates in clinical performance improvement activities.
NewRN Case Manager Inpatient Care Coordinator (Case Management) Macpower Digital Assets Edge Private LimitedRN Case Manager Inpatient Care Coordinator (Case Management)Silver Spring, MDRole Overview: The RN Case Manager (Inpatient Care Coordinator - ICC) plays a crucial role within the interdisciplinary team, overseeing patient care from admission to transfer or discharge. Discharge Planning Leadership : Lead the team in creating complex discharge plans that balance cost-effective hospital resource use with minimized patient expenses.
Referral Management (Non-Nurse) Reviewer Zimmerman Associates IncReferral Management (Non-Nurse) ReviewerBethesda, MDEssential Tasks: Review and process referrals for administrative and clinical completeness and appropriateness, completing disposition within 24 hours of referral date Collaborate with appointing centers, case managers, product line nurses, providers, clinics, managed care contractors, and other healthcare team members to ensure appropriate use of Direct Care and civilian network resources Ensure patients are scheduled with the right provider, at the right time and place Review compliance with Specialty Referral Guidelines (SRGs) per IRMAC protocols Complete and return Clear Legible Reports (CLR) to ordering civilian providers within required Return of Favorable Response (ROFR) timelines Manage telephone, written, and electronic communications regarding specialty appointments and referrals Monitor and process referral management worklists (e.g., Genesis Work Lists) to ensure timely consult processing Communicate referral status to patients, including benefit counseling and advocacy resources as needed Reschedule or redirect patients within 3 days when referrals are disapproved or invalid, advising on other care options and Line-of-Duty issues Receive and enter ROFR referrals in MHS-GENESIS from Military Contractor Support Centers (MCSC) portals for assigned specialties/product lines, adhering to all timelines and business rules Verify patient eligibility and update demographics in MHS-GENESIS Document patient interactions, especially when appointments are refused, and coordinate with Beneficiary Counselor and Assistance Coordinator as appropriate Coordinate with product line nurses and clinics for special accommodations Interface with MCSC and multidisciplinary teams to ensure referral appropriateness Submit referrals to non-network providers for TRICARE Service Center medical necessity reviews Monitor referral management voicemail and return patient calls within established guidelines Provide External Provider Referral Online (EPRO) information as requested Close unused referrals following DHA IPM and NCR Medical Directorate policies, notifying ordering providers accordingly Orient and train new IRMAC staff on referral processes and timelines Perform other duties as assigned. Zimmerman Associates, Inc. (ZAI) is seeking to hire multiple Referral Management (Non-Nurse) Reviewers to support our contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Region's premier authority for appointment coordination and referral management services for beneficiaries within the Defense Health Network.
Remote Care Management Nurse Cambia Health Solutions IncRemote Care Management NurseWashington, DCRemote$36.80–$49.80 / hourAs a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.
Nurse Case Management US Department of Health and Human ServicesNurse Case ManagementDC$84,363–$127,725 / yearMINIMUM QUALIFICATIONS: Your resume must demonstrate at least one (1) year of specialized experience equivalent to at least the next lower grade level in the Federal service obtained in either the private or public sector performing the following type of work and/or tasks: Serving as Clinical Liaison and Case Manager to coordinate and manage referrals for primarily uninsured and referral patients. This education must have been accredited by the Commission on Collegiate Nursing Education(external link), Council on Accreditation of Nurse Anesthesia Educational Programs(external link), Accreditation Commission for Midwifery Education(external link), or an accrediting body recognized by the U.S. Department of Education(external link) at the time the degree was obtained.
RN Case Manager Mercy Medical CenterRN Case ManagerBaltimore, MarylandFull timeResponsibilities: The RN Case Manager applies case management strategies to assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's healthcare needs, through communication and the use of available resources to promote quality, cost effective outcomes. The RN Case Manager responsibilities include assessing clients needs, developing individualized care plans, coordinating with physicians, social workers and ancillary staff, and advocating for clients' rights and access to resources.
RN Case Manager - Cardiac Med/Surg Johns Hopkins HospitalRN Case Manager - Cardiac Med/SurgBaltimore, MDWhat you will bring: Completion of an accredited RN Nursing Program; BSN preferred One year of RN experience required; cardiac experience highly preferred Preferred experience in case management, discharge planning or utilization review Valid Maryland Nursing License required Active BLS CPR is required. The Case Manager manages clinical resources and transition planning for patients within an assigned caseload from pre-admission through post-discharge, actively working to identify/ eliminate barriers to the delivery of clinical services with the patient, family and care team.
RN Case Manager Johns Hopkins HospitalRN Case ManagerBaltimore, MDThe Case Manager manages clinical resources and transition planning for patients within an assigned caseload from pre-admission through post-discharge, actively working to identify/ eliminate barriers to the delivery of clinical services with the patient, family and care team. What You Will Do: In collaboration with patients/families, social workers, physicians and the interdisciplinary team, the Case Manager provides leadership and advocacy in the coordination of patient-centered care across the continuum to facilitate optimal transitions and progression in care.
RN Case Manager - Pediatric Heart Center Johns Hopkins HospitalRN Case Manager - Pediatric Heart CenterBaltimore, MDThe Case Manager manages clinical resources and transition planning for patients within an assigned caseload from pre-admission through post-discharge, actively working to identify/ eliminate barriers to the delivery of clinical services with the patient, family and care team. What You Will Do: In collaboration with patients/families, social workers, physicians and the interdisciplinary team, the Case Manager provides leadership and advocacy in the coordination of patient-centered care across the continuum to facilitate optimal transitions and progression in care.
Director of Nursing (RN) Operating Room, Abdominal Transplant, Urology and General Surgery MedStar Health Research InstituteDirector of Nursing (RN) Operating Room, Abdominal Transplant, Urology and General SurgeryDC$120,702–$238,222 / yearMaintains knowledge of current trends and developments in the fields of nursing and health care through a variety of professional activities including but not limited to reading the appropriate literature attending related seminars and conferences and maintaining membership in professional nursing associations. Engages in ongoing productivity monitoring adherence to prescribed annual budget and assurance of adequate availability of personnel and other necessary resources to support the delivery of safe patient care and realization of departmental goals.
RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program MedStar Health Research InstituteRN Bilingual Case Manager - Breast & Cervical Cancer Outpatient ProgramBaltimore, MDManages patient care according to clinical pathways and/or multidisciplinary plan of care and/or management care contracts by directing decision making and identifying and managing barriers that impact on patient care outcomes. The RN Case Manager provides community-based care coordination and clinical support as a member of a small, collaborative team serving predominantly Spanish-speaking women age 40 and older residing in Baltimore City.
Nurse Practitioner ChenMedNurse PractitionerEdgewood, Maryland$111,140–$158,771 / yearThe Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment or providing assessments to members in SNF and home settings. Plans patient care based on in-depth knowledge of the specific patient population and/ or protocol, anticipating and identifying physiological and/ or psychological problems commonly encountered including the consideration of the patient’s cultural background, level of understanding, personality and support systems.
Field RN Case Manager MedStar Health Research InstituteField RN Case ManagerBaltimore, MD$89,065–$162,801 / yearThey are also responsible for the report of Enrollees requiring assistance with Medicare and/or Medicaid beneficiary support Medicaid for Nursing Home Placement Crime Victims Vocational Rehabilitation and any/all other third-party coverage including other available local state and federal programs. Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities.
RN - Nurse Navigator-Specialty MHM Support ServicesRN - Nurse Navigator-SpecialtyWashingtonThis position is designed to facilitate an effective process of the new care model; supporting quality patient care, safety, and financial components; promoting integration of a seamless care model; coordinating patient discharge planning for post-acute services, length of stay (LOS) management and utilization management; collaborating to include coordination as evidenced by metrics, optimizing performance and adoption of best practice. This role coordinates patient care, provides education and support, helps with discharge planning, and works closely with physicians, nurses, and other healthcare team members to ensure excellent patient outcomes.
NewTransition of Care RN CINQCARETransition of Care RNWASHINGTON, DCRemote$76,794–$94,000 / yearParticipate in Daily Hospital Census Rounds forum to discuss the patient’s inpatient status, anticipated discharge and create a post discharge care plan in conjunction with the PHN, Nurse Case Manager and PCP, leveraging others in the Care Team as required. . The Transition of Care RN reports to the Director of Clinical Operations or designee, with accountability for providing strategy, judgment, organization, and evidence-based analysis to influence decisions, and directly to meet Care at Home’s requirements.
Referral Management Reviewers (Bethesda, MD) Ivyhill Technologies LLCReferral Management Reviewers (Bethesda, MD)Bethesda, MD$47,000Collaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to ensure proper use of Direct Care system and civilian network resources, as well as to ensure that patients are booked at the right time, with the right provider, at the right place. Team Ivyhill is currently seeking to hire Referral Management (Non-Nurse) Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network.
NewRN Case Manager (Discharge Planner) MedStar HealthRN Case Manager (Discharge Planner)Washington, DC$89,065–$162,801 / yearFull timeDemonstrates the ability to develop a plan of care that addresses needs across the continuum; have an intervention for problems identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives. Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal clinical and resource outcomes for the acute and post-hospital phases of care.