Top 225 Utilization management Jobs in Annapolis Md

Utilization Reviewer
University of Maryland Medical System —Largo, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
8d
Utilization Management Specialist II
University of Maryland Medical System —Baltimore, MD
- Full-time
- RN License
- Mid-level
- Analysis skills
Care Manager (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $72,360 - $143,715 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
10d
Clinical Medical Review Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,320 - $133,705 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
10d
Utilization Management Supervisor (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $82,800 - $170,775 a year
- Full-time
- Nursing
- RN License
- Mid-level
- 401(k)
Quick Apply
5d
Utilization Management Nurse
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
- AD&D insurance
- Paid holidays
Clinical Care Coordinator
University of Maryland Medical System —Largo, MD
- $47.00 - $70.54 an hour
- Full-time
- Nursing
- RN License
- Hospital
Case Manager I
University of Maryland Medical System —Baltimore, MD
- Weekends as needed
- Acute care
- Nursing
- RN License
Clinical Support Supervisor (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $62,280 - $128,453 a year
- Full-time
- Bilingual
- Microsoft Excel
- Mid-level
- 401(k)
Quick Apply
Coordinator - Prior Authorization Verification and Eligibility
Luminis Health —Annapolis, MD
- $17.50 - $26.00 an hour
- Full-time
- Microsoft Outlook
- Hospital
- Medical office experience
- AD&D insurance
- Paid holidays
Behavioral Health Coordinator
MedStar Health —Colmar Manor, MD
- $20.57 - $36.27 an hour
- Full-time
- Psychiatry
- Mid-level
- Master's degree
Utilization Management Director - Inpatient (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $135,040 - $250,668 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
Case Manager
Mercy Medical Center —Baltimore, MD
- $36.92 - $66.46 an hour
- Full-time
- Nursing
- RN License
- Hospital
- 403(b) matching
- Paid holidays
2d
Hybrid Clinical Supervisor/BCBA - Federal Hill
Helping Hands Family —Baltimore, MD
- $100,000 - $115,000 a year
- Hybrid work
- Background check
- Clinic
- Supervising experience
- Continuing education credits
- Health insurance
Quick Apply
Hybrid Clinical Supervisor/BCBA - Lanham - $10,000 sign on bonus
Helping Hands Family —Lanham, MD
- $100,000 - $120,000 a year
- Hybrid work
- Background check
- Clinic
- Supervising experience
- Continuing education credits
- Health insurance
Quick Apply
Clinical Supervisor - Suitland - $10,000 sign on bonus
Helping Hands Family —Suitland, MD
- $100,000 - $120,000 a year
- Background check
- Clinic
- Supervising experience
- Continuing education credits
- Health insurance
Quick Apply
Regional Clinical Manager - Pediatric Urgent Care (PA/NP)
PM Pediatrics Management Group —Laurel, MD
- $150,000 - $200,000 a year
- Full-time
- Nursing
- Urgent Care
- Pediatrics
Quick Apply
BEHAVIOR SPECIALIST (DEGREE REQUIRED)
The Foundation Schools —Largo, MD
- $35,600 - $46,200 a year
- Full-time
- Classroom
- Spanish
- Mid-level
Quick Apply
11d
Director, Pediatrics
Chase Brexton Health Care —Baltimore, MD
- $240,000 - $250,000 a year
- Full-time
- Medicine
- Clinic
- Children
Quick Apply
RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program
MedStar Health —Baltimore, MD
- $86,000 a year
- Full-time
- Background check
- Spanish
- Nursing
Quick Apply

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utilization management jobs near annapolis md

Utilization Reviewer

University of Maryland Medical System -
Largo, MD

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Job Details

Full-time
$40.61 - $60.96 an hour
8 days ago

Qualifications

Collaborate with healthcare professionals
RN License
Bachelor's degree
Bachelor's degree in nursing
Computer skills
Healthcare software applications
Team building

Full Job Description

Job Requirements

Located in Largo in the heart of Prince George’s County, our state-of-the-art regional medical center (University of Maryland Capital Region Medical Center) will provide improved access to primary and ambulatory care services and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George’s County residents.

Position Summary:

Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient’s need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.

Primary Responsibilities:

Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.

Communicates with clinical care coordinators, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.

Supports concurrent appeals process through proactive identification of pended/denied days.

Implements the concurrent appeals process with appropriate referrals and documentation.

Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg).

Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner.

Conducts HINN discussions/Observation Education.

Collaborates with Clinical Care Coordinators concerning Avoidable Days Collection.

Ensures Regulatory Compliance related to Utilization Management conditions of participation.

Assures appropriate reimbursement and stewardship of organizational and patient resources.

Pursues and reports opportunities to improve reimbursement.

Collaborates with admitting specialists regarding authorization policies and procedures of third-party payers. Remains current on clinical practice and protocols impacting clinical reimbursement.

Work Experience

Education Bachelors in Nursing required.

Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required

One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred.

Two years’ experience in acute care and four years clinical healthcare experience preferred.

Certified Professional Utilization Reviewer (CPUR) preferred.

Additional experience in home health, ambulatory care, and/or occupational health is preferred.

Knowledge, Skills and Abilities

1. Highly effective verbal and written skills are required.

2. Strong communication skills, self-confidence and experience in working with physicians are required.

3. Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.

4. The ability to work collaboratively with other disciplines is required.

5. Ability to work with Hospital/ Utilization Management and related software programs is required.

6. Knowledge of utilization management is preferred.

Benefits

All your information will be kept confidential according to EEO guidelines.

Compensation:

Pay Range: $40.61-$60.96
Other Compensation (if applicable):

Review the 2024-2025 UMMS Benefits Guide

Apply Now

Refine Your Search

utilization management jobs in annapolis md

Utilization Reviewer

Utilization Management Specialist II

Care Manager (Remote)

Clinical Medical Review Nurse (Remote)

Utilization Management Supervisor (Hybrid)

Utilization Management Nurse

Clinical Care Coordinator

Case Manager I

Clinical Support Supervisor (Hybrid)

Coordinator - Prior Authorization Verification and Eligibility

Behavioral Health Coordinator

Utilization Management Director - Inpatient (Hybrid)

Case Manager

Hybrid Clinical Supervisor/BCBA - Federal Hill

Hybrid Clinical Supervisor/BCBA - Lanham - $10,000 sign on bonus

Clinical Supervisor - Suitland - $10,000 sign on bonus

Regional Clinical Manager - Pediatric Urgent Care (PA/NP)

BEHAVIOR SPECIALIST (DEGREE REQUIRED)

Director, Pediatrics

RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program

I want to receive the latest job alert for utilization management in annapolis md

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