LifeBridge HealthNewUtilization 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.
TravelNurseSourceNewTravel Nurse RN - Utilization Review - $1,461 per week in Baltimore, MD TravelNurseSourceTravel Nurse RN - Utilization Review - $1,461 per week in Baltimore, MDBaltimore, MD$1,461–$1,461Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
MedStar HealthEmergency Department Nurse Manager - Relocation Offered! MedStar HealthEmergency Department Nurse Manager - Relocation Offered!Olney, MD$120,702–$238,222Maintains 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.
MedStar HealthNewDirector of Nursing (RN) Operating Room, Abdominal Transplant, Robotics and General Surgery - Relocation Offered! MedStar HealthDirector of Nursing (RN) Operating Room, Abdominal Transplant, Robotics and General Surgery - Relocation Offered!Washington, DC$120,702–$238,222Maintains 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.
MedStar HealthNewNursing Director (RN) Behavioral Health - Relocation Offered! MedStar HealthNursing Director (RN) Behavioral Health - Relocation Offered!Washington, DC$120,702–$238,222Maintains 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.
MedStar HealthNewClinical Nurse Medstar 1G 36/hr D/N - Relocation Offered! MedStar HealthClinical Nurse Medstar 1G 36/hr D/N - Relocation Offered!Washington, DC$41.38–$94.97CLINICAL: Identifies current and potential complex problems of a specific patient population critically analyzes trends and changes in patient status and plans appropriate interventions directly or indirectly through other nurses. CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required .
Fresenius Medical CareNewDialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNWashington, DC$90,000–$150,000 / hourAs 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.
One MedicalNewPrimary Care Nurse Practitioner or Physician Assistant One MedicalPrimary Care Nurse Practitioner or Physician AssistantWASHINGTON, DCIn the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting, OR 1 year in an outpatient primary care setting, coupled with either a 1 year primary care fellowship or 1+ year in an urgent care setting. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.
One MedicalNewPrimary Care Nurse Practitioner or Physician Assistant - Multiple DC openings! One MedicalPrimary Care Nurse Practitioner or Physician Assistant - Multiple DC openings!WASHINGTON, DCIn the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting, OR 1 year in an outpatient primary care setting, coupled with either a 1 year primary care fellowship or 1+ year in an urgent care setting. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.
Yale New Haven HealthMedical-Surgical Registered Nurse (Med-Surg RN) Yale New Haven HealthMedical-Surgical Registered Nurse (Med-Surg RN)Woodlawn, NYThis specialized department caters to both medical oncology patients, who receive systemic therapies like chemotherapy, immunotherapy, and targeted therapies, and surgical oncology patients, who are in various stages of their surgical journey, including pre-operative evaluation, post-operative care, and follow-up. Additional Information Smilow Ambulatory Multispecialty Department YSC (NP 1, NP4, NP8) This department is rooted in oncology nursing excellence and serves as a hub for patients undergoing cancer treatment and management for solid tumor cancers.
MedStar HealthClinical Nurse 4H Burn/Trauma 36/hr D/N - Relocation Offered! MedStar HealthClinical Nurse 4H Burn/Trauma 36/hr D/N - Relocation Offered!Washington, DC$41.38–$94.97CLINICAL: Identifies current and potential complex problems of a specific patient population critically analyzes trends and changes in patient status and plans appropriate interventions directly or indirectly through other nurses. CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required .
One MedicalNewFamily Medicine Nurse Practitioner (Casual Employee) One MedicalFamily Medicine Nurse Practitioner (Casual Employee)WASHINGTON, DCOur seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years. Seeing patients with a broad array of patient needs; conducting a mix of acute, chronic, and well visits (not a panel-building role).
MedStar HealthNewRegistered Nurse RN Endoscopy Day Evening - Relocation Offered! MedStar HealthRegistered Nurse RN Endoscopy Day Evening - Relocation Offered!Washington, DC$41.38–$94.97CLINICAL: Identifies current and potential complex problems of a specific patient population critically analyzes trends and changes in patient status and plans appropriate interventions directly or indirectly through other nurses. CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required .
Careers Integrated Resources IncRegistered Nurse (RN) – Case Manager Careers Integrated Resources IncRegistered Nurse (RN) – Case ManagerArlington, VAThe Nurse collaborates with rounding MAPMG Hospital Based Service Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure continuum of patient care progressions for clinical and cost-effective outcomes. The Nurse facilitates and coordinates with community providers and ambulatory case managers to assist with the appropriate level and transition of care for a safe discharge and preventing a re-admission.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,356 per week in Bel Air, MD TravelNurseSourceTravel Nurse RN - Case Manager - $2,356 per week in Bel Air, MDBel Air, MD$2,355.60–$2,355.60Works closely with providers, social workers, and external agencies to ensure timely, efficient, and effective discharge planning and transitions. TravelNurseSource is working with Prime Staffing to find a qualified Case Manager RN in Bel Air, Maryland, 21014!
TravelNurseSourceNewTravel Nurse RN - Case Manager - $2,500 to $2,650 per week in Silver Spring, MD TravelNurseSourceTravel Nurse RN - Case Manager - $2,500 to $2,650 per week in Silver Spring, MDSilver Spring, MD$2,500–$2,650Job Title: RN Case Manager / Patient Care Coordinator Location: Silver Spring, MD (Holy Cross Hospital – 1500 Forest Glen) Shift: Day Shift (08:30 AM – 05:00 PM) Schedule: 40 Hours/Week Duration: 560 Hours Assignment Start Date: ASAP Position Details:Department: Continuum of Care. The candidate will collaborate closely with physicians, nursing staff, patients, families, and interdisciplinary teams to facilitate smooth transitions of care and prevent hospital readmissions.
One MedicalNewVirtual Family Nurse Practitioner- DC Licensed One MedicalVirtual Family Nurse Practitioner- DC LicensedWashington, DC$59.10–$65.50 / hourIn the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting seeing patients of all ages (0+), OR 2 years in an urgent care or emergency medicine setting seeing patients of all ages (0+) . The One Medical Virtual Medical Team (VMT) is a leading provider of virtual clinical care, providing world-class, convenient, evidence-based virtual medical care to One Medical patients in concert with their primary care providers.
Managed Care AdvisorsNewMedical Case Manager EI (Remote) 2026-1463 Managed Care AdvisorsMedical Case Manager EI (Remote) 2026-1463Bethesda, MDRemote$70,000–$80,000 / yearAll resumes submitted by search firms to any employee at Government Solutions without a valid written agreement and task order in place will be deemed the sole property of Government Solutions and no fee will be paid in the event that person is hired by Government Solutions. We believe in helping those with work-sustained illnesses and injuries to live their best life by providing care, health management, and support through our highly skilled team of home-based Medical CaseManagers (MCM).
MedStar Health Research InstituteRN Utilization Management MedStar Health Research InstituteRN Utilization ManagementWashington, DC$89,065–$162,801 / yearRN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred. Responsible for clinical review of acute care services based on Medically Necessity criteria, the management of quality health care resources for achievement of desired outcomes, and coordination of alternative levels of care in a timely and cost-effective manner.
MedStar HealthRN Utilization Management MedStar HealthRN Utilization ManagementWashington, DC$89,065–$162,801 / yearResponsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner. Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs.
CVS Health CorpNewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantWork At Home, DC$29.10–$62.32 / hourUtilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. 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.
Blue Cross and Blue Shield AssociationNewUtilization Management Specialist - RN (Remote) Blue Cross and Blue Shield AssociationUtilization Management Specialist - RN (Remote)DCRemote$72,360–$143,715 / yearNote: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. QUALIFICATIONS: Education Level: Bachelor''s Degree in Nursing OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Sinai Hospital of BaltimoreNewUtilization 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.
Lumen Solutions Group IncUtilization Review Nurse Lumen Solutions Group IncUtilization Review NurseBaltimore, MDFull timeRole: Utilization Review Nurse Location: Baltimore MD(Remote) Type: Contract Job Description: We are seeking an experienced Utilization Review Nurse (LPN or RN) to support high-volume clinical reviews for commercial and FEP health plans. The ideal candidate will have strong utilization management and care management experience, expertise with MCG guidelines, and the ability to manage a fast-paced review environment while ensuring quality and compliance.
Johns Hopkins HospitalNewUtilization Review Nurse - Managed Care Johns Hopkins HospitalUtilization Review Nurse - Managed CareHanover, MDRemoteAs a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States.
MedStar HealthNewRN Utilization Review (PRN) MedStar HealthRN Utilization Review (PRN)Washington, DC$89,065–$162,801 / yearServes as a resource to the health care team by educating the health care team through in-services staff meetings and formal educational settings in areas of utilization management. Performs patients' medical record reviews document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials.
Ampcus IncorporatedSpec, 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.
MedStar HealthRN Utilization Mgmt MedStar HealthRN Utilization MgmtWashington, DC$89,065–$162,801 / yearResponsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner. Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs.
Baptist Health South Florida IncUtilization 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.
Ampcus IncorporatedHealth Services - Utilization Management Specialist Ampcus IncorporatedHealth Services - Utilization Management SpecialistBaltimore, MD$40–$48.21 / hourKnowledge, Skills and Abilities (KSAs):Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues, Proficient. 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.
Lumen Solutions Group IncSpec, Utilization Management Lumen Solutions Group IncSpec, Utilization ManagementBaltimore, MDFull timeLicenses/Certifications RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Req or LPN - Licensed Practical Nurse - State Licensure CNS-Clinical Nurse Specialist Pref Additional Skills: Clinical UM expertise, regulatory compliance knowledge, experience in Guiding care platform ***Lumen and / or its clients will not provide equipment (Laptop, monitor, etc.) to the selected contractor. Education Level: Bachelor's Degree Education Details: Nursing Experience: 5 years Clinical nursing experience 2 years Care Management In Lieu of Education In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
TriWest Healthcare AllianceUtilization 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.
CambiaNewRemote Care Management Nurse CambiaRemote 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.
Blue Cross and Blue Shield AssociationBehavioral Health Utilization Mgmt Clinician, Senior Blue Cross and Blue Shield AssociationBehavioral Health Utilization Mgmt Clinician, SeniorWashington, DCIn this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business.
Inova Health SystemManager 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.
AmeriHealth CaritasCare Management, Registered Nurse - Hybrid | Washington, D.C. AmeriHealth CaritasCare Management, Registered Nurse - Hybrid | Washington, D.C.washington, DC$78,600–$107,100 / yearWhat We're Looking For:Clinical experience in complex care e.g., high-risk, medically fragile, or chronic), behavioral health, pediatrics, or transitions of careActive RN Licensure in DC required, compact licensure strongly preferred, or LICSWKnowledge of tools like InterQual or JIVAPassion for Medicaid populations and purpose-driven care4 days onsite, 1day remoteWhat You'll Find Here:An engaged, mission-first team that values clinical voicesA place where your decisions protect real peopleGrowth, mentorship, and space to leadCompetitive pay ($78,600-$107,100) plus a $5,000 sign-on bonusYou've reviewed cases. At AmeriHealth Caritas D.C., we're hiring licensed clinical professionals to join our Care Management team, supporting diverse member needs across adult, pediatric, behavioral health, and complex care populations.
Macpower Digital Assets Edge Private LimitedRN 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.
Mercy Medical CenterRN Case Manager Mercy Medical CenterRN Case ManagerBaltimore, MarylandResponsibilities: 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.
Lumen Solutions Group, Inc.Clinical Medical Review Nurse Lumen Solutions Group, Inc.Clinical Medical Review NurseBaltimore, MDWe provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.
TalteamHealth Services - Nurse, Clinical Medical Review TalteamHealth Services - Nurse, Clinical Medical ReviewBaltimore, MDESSENTIAL FUNCTIONS: 35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, Performs high-level research on topics identified as actual or potential medical policies. The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication.
Ampcus IncorporatedClinical Medical Review Nurse Ampcus IncorporatedClinical Medical Review NurseOwings Mills, MD$40–$45 / hourThe Contingent RN supports CareFirst by analyzing high cost claimant and population health data to support utilization review, ad hoc requests, and client reports. Role Characteristics:Individual contributor who researches high cost claimants, populates slide decks, and responds to ad hoc requests.
Sinai Hospital of BaltimoreNewCase Manager RN Sinai Hospital of BaltimoreCase Manager RNRandallstown, MDSupport: 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.
Lumen Solutions Group IncClinical Medical Review Nurse Lumen Solutions Group IncClinical Medical Review NurseBaltimore, MDFull timeRole: Clinical Medical Review Nurse Location: Canton, MD – Hybrid (2–3 days/week) Job Type: Contract Job Summary: We are seeking an experienced Clinical Medical Review Nurse to perform medical record reviews, data abstraction, and claims evaluation. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support.
MindlanceHealth Services - Nurse, Clinical Medical Review MindlanceHealth Services - Nurse, Clinical Medical ReviewBaltimore, MDESSENTIAL FUNCTIONS: 35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, Performs high-level research on topics identified as actual or potential medical policies. Job Description:PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication.
MedStar Health Research InstituteNewDirector 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 SurgeryWashington, DC$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.
MedStar Health Research InstituteEmergency Department Nurse Manager MedStar Health Research InstituteEmergency Department Nurse ManagerOlney, MD$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.
MedStar Health Research InstituteNursing Director (RN) Cardiac Stroke Unit MedStar Health Research InstituteNursing Director (RN) Cardiac Stroke UnitWashington, DC$120,702–$238,222 / yearMinimal Qualifications Education Bachelor's degree in Nursing from a nationally accredited program required Master's degree in Nursing or health related field from a nationally accredited program preferred Experience 5-7 years in Nursing or health related field from a Nationally accredited program required 1-2 years of management and leadership experience preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia required CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required Additional unit/specialty certifications may vary by department or business unit. Specialty certification from a nationally recognized nursing organization in either his/her clinical specialty or Nursing Administration within 2 years required Knowledge Skills and Abilities Excellent problem-solving skills and ability to exercise independent judgment on highly complex situations.
MedStar Health Research InstituteRN 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.
MedStar Health Research InstituteNewNursing Director (RN) Behavioral Health MedStar Health Research InstituteNursing Director (RN) Behavioral HealthWashington, DC$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.