Top 472 General practitioner Jobs in Washington, Dc

RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Certified Registered Nurse Anesthetist (CRNA)
Inova Health System —Fairfax, VA
- $224,000 - $270,000 a year
- Weekends as needed
- Nursing
- Surgery
- RN License
- Wellness program
- Paid parental leave
Quick Apply
Wound Ostomy Continence Nurse (RN) WOCN
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- BLS Certification
- Health insurance
- Tuition reimbursement
Wound Ostomy Continence Registered Nurse (RN)
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Background check
- Nursing
- RN License
Quick Apply
10d
Primary Care and Urgent Care Nurse Practitioner
Privia Medical Group —Falls Church, VA
- $125,000 - $135,000 a year
- Full-time
- Hybrid work
- Urgent Care
- Primary Care
- HIPAA
- Disability insurance
- Health insurance
Quick Apply
Associate Attorney- Relocation Required
Parnall Law —Alexandria, VA
- $200,000 - $400,000 a year
- Full-time
- 5 years
- Senior level
- Paid holidays
- Disability insurance
Quick Apply
RN In Hospital Transiton of Care Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Background check
- Nursing
- Microsoft Excel
Quick Apply
RN In Hospital Transition of Care Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- Psychiatry
Quick Apply
Certified Medical Assistant
The Pediatric Group LLP —Davidsonville, MD
- From $21 an hour
- Full-time
- Background check
- Word processing
- Windows
- Health insurance
- Dental insurance
Quick Apply
Organizational Psychologist
Central Intelligence Agency —Washington, DC
- $179,891 - $288,000 a year
- Full-time
- 5 years
- Doctor of Philosophy
- Travel
- Health insurance
- Dental insurance
Senior Release Manager
Leidos —Chantilly, VA
- $107,900 - $195,050 a year
- Full-time
- Doctoral degree
- Computer Science
- 5 years
Nurse Coordinator
Choice Respect Independence - CRi —Chantilly, VA
- From $93,600 a year
- Full-time
- Nursing
- Clean driving record
- RN License
- Paid training
- Health insurance
Quick Apply
RN Manager Grievances & Appeals
MedStar Health —Columbia, MD
- $102,606 - $196,996 a year
- Full-time
- Hybrid work
- Microsoft Word
- Background check
- Nursing
Quick Apply
8d
Nurse Practitioner (NP) - Hospitalist Medicine
Rhino Medical Services —Washington, DC
- Acute care
- Inpatient
- Critical & Intensive Care
Quick Apply
Information System Security Officer (ISSO) - TS/SCI with Polygraph
General Dynamics Information Technology —McLean, VA
- $119,582 - $161,788 a year
- Azure
- Computer Science
- 5 years
- Paid holidays
- 401(k) matching
Senior Release Manager
Leidos —Gaithersburg, MD
- $107,900 - $195,050 a year
- Full-time
- Doctoral degree
- Computer Science
- 5 years
Wound Care Ostomy and Continence Nurse (WOCN)
MedStar Health —Clinton, MD
- $37.50 - $54.92 an hour
- Full-time
- Background check
- Nursing
- RN License
Quick Apply
DevOps Engineer - TS/SCI with Polygraph
General Dynamics Information Technology —Herndon, VA
- $158,855 - $214,921 a year
- Computer Science
- System design
- Bachelor's degree
- Paid holidays
- 401(k) matching
Family Nurse Practitioner
Privia Medical Group —Fairfax, VA
- From $120,000 a year
- Full-time
- HIPAA
- Mid-level
- Outpatient experience
- Health insurance
- Dental insurance
Quick Apply
Senior Release Manager
Leidos —Alexandria, VA
- $107,900 - $195,050 a year
- Full-time
- Doctoral degree
- Computer Science
- 5 years

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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

general practitioner jobs in washington, dc

RN Case Manager

Certified Registered Nurse Anesthetist (CRNA)

Wound Ostomy Continence Nurse (RN) WOCN

Wound Ostomy Continence Registered Nurse (RN)

Primary Care and Urgent Care Nurse Practitioner

Associate Attorney- Relocation Required

RN In Hospital Transiton of Care Case Manager

RN In Hospital Transition of Care Case Manager

Certified Medical Assistant

Organizational Psychologist

Senior Release Manager

Nurse Coordinator

RN Manager Grievances & Appeals

Nurse Practitioner (NP) - Hospitalist Medicine

Information System Security Officer (ISSO) - TS/SCI with Polygraph

Senior Release Manager

Wound Care Ostomy and Continence Nurse (WOCN)

DevOps Engineer - TS/SCI with Polygraph

Family Nurse Practitioner

Senior Release Manager

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