Top 79 Acd Jobs in Washington, Dc

RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Call Center Agent
Zimmerman Associates, Inc. —Bethesda, MD
- $21.50 an hour
- Microsoft Outlook
- Computer literacy
- Primary Care
2d
RN Utilization Management
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
- Vision insurance
Clinic Operations Representative
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
12d
Patient Access Representative
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- Microsoft Excel
- Computer literacy
- Mid-level
- Commuter assistance
- AD&D insurance
12d
Patient Access Rep- 8 hours weekly- Weekend
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Part-time
- Microsoft Excel
- Computer literacy
- HIPAA
12d
Principal Associate, ACD, Copywriter — Brand Creative
Information Technology Senior Management Forum —McLean, VA
- $120,800 - $137,900 a year
- Email
- Military
- Bachelor's degree
- Fair chance
- Health insurance
Patient Access Representative (PRN | As Needed)
Children's National Hospital —Prince George's County, MD
- $20.75 - $40.99 an hour
- PRN
- Microsoft Excel
- Computer literacy
- HIPAA
12d
Clinic Operations Representative - Primary Care TheARC
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- Primary Care
- HIPAA
- Commuter assistance
- AD&D insurance
12d
Clinic Operations Representative - Ambulatory Center Services
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Clinic Operations Representative - Takoma Theater (Washington, DC)
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Access Call Center Representative
Children's National Hospital —Silver Spring, MD
- $18.54 - $30.89 an hour
- Full-time
- Computer literacy
- Mid-level
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Clinic Operations Representative - Primary Care Shepherd Park
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- Primary Care
- HIPAA
- Commuter assistance
- AD&D insurance
12d
Clinic Operations Representative - ENT Clinic (Washington, DC)
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Unified Communications (UC) Engineer
AHU Technologies Inc —Washington, DC
- $45 - $50 an hour
- Full-time
- Hybrid work
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
Quick Apply
Technology Support Specialist
McDermott Will & Emery —Washington, DC
- $87,000 - $110,000 a year
- Full-time
- Mid-level
- Office
- Organizational skills
Clinic Operations Representative - PRN, Montgomery County (Mon - Fri, Day Shift)
Children's National Hospital —Silver Spring, MD
- $20.75 - $40.99 an hour
- PRN
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Clinic Operations Representative - Cancer and Blood Disorders Clinic
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Clinic Operations Representative - Heart, Lung Kidney Clinics
Children's National Hospital —Washington, DC
- $20.75 - $40.99 an hour
- Full-time
- In person
- Microsoft Excel
- HIPAA
- High school diploma or GED
- Commuter assistance
- AD&D insurance
12d
Senior Patient Access Representative (PRN|As Needed)
Children's National Hospital —Washington, DC
- $21.17 - $42.35 an hour
- PRN
- Microsoft Excel
- Computer literacy
- Mid-level
12d

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RN Case Manager

MedStar Health -
Washington, DC

Apply Now

Job Details

Full-time
$89,065 - $162,801 a year

Qualifications

RN License
Managing patients as a nurse case manager
Utilization management
Decision making
Patient care
Resource utilization in healthcare
Negotiation

Full Job Description

About this Job:

General Summary of Position

Coordinates negotiates procures and manages care of our members/enrollees to facilitate cost effective care and members/enrollees satisfaction. Facilitates the continuum of care works collaboratively with interdisciplinary staff internal and external to the organization. Responsible for carrying a complex case management case load ownership of a case management program(s) pre- authorization reviews to provide Medically Necessary timely and quality health care services in the most cost-effective manner and pharmacy reviews per population served. This role would include the ability to meet memebers in their homes or various community settings. We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.

Primary Duties and Responsibilities

Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
Provides face to face case management in the community as the member/enrollee's health necessitate.
Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
Demonstrates skill and flexibility in providing coverage for other staff.
For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy.
Monitors utilization of all services for fraud waste and abuse.
Performs telephonic ACD line coverage for Clinical Operations' needs.
Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
Participates in multi-disciplinary quality and service improvement teams.

Minimal Qualifications
Education

Graduate of an accredited School of Nursing required and
Bachelor's degree preferred

Experience

1-2 years Case management experience required and
1-2 years UM or related experience required and
3-4 years Diverse clinical experience required

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and
CCM - Certified Case Manager Upon Hire preferred

Knowledge Skills and Abilities

Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.

This position has a hiring range of : USD $89,065.00 - USD $162,801.00 /Yr.

Apply Now

Refine Your Search

acd jobs in washington, dc

RN Case Manager

Call Center Agent

RN Utilization Management

Clinic Operations Representative

Patient Access Representative

Patient Access Rep- 8 hours weekly- Weekend

Principal Associate, ACD, Copywriter — Brand Creative

Patient Access Representative (PRN | As Needed)

Clinic Operations Representative - Primary Care TheARC

Clinic Operations Representative - Ambulatory Center Services

Clinic Operations Representative - Takoma Theater (Washington, DC)

Access Call Center Representative

Clinic Operations Representative - Primary Care Shepherd Park

Clinic Operations Representative - ENT Clinic (Washington, DC)

Unified Communications (UC) Engineer

Technology Support Specialist

Clinic Operations Representative - PRN, Montgomery County (Mon - Fri, Day Shift)

Clinic Operations Representative - Cancer and Blood Disorders Clinic

Clinic Operations Representative - Heart, Lung Kidney Clinics

Senior Patient Access Representative (PRN|As Needed)

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