Nursing Residency (Transition to Practice Program)
Utilization review nurse job in Washington, DC
About Our ANCC Practice Transition Accreditation Program (PTAP)
Transition to Practice Program is accredited with distinction as a Practice Transition Program by the American Nurses Credentialing Center's Commission on Accreditation in Practice Transition Programs.
The current sites included in this accreditation with distinction designation are:
Children's National Hospital (Sheikh Zayed Campus)
Children's National Hospital ED @ UMC
The current workplace settings included in this accreditation with distinction designation are:
Medical-Surgical
Oncology
Critical Care
Neonatal Intensive Care Unit (NICU)
Pediatric Intensive Care Unit (PICU)
Operating Room
Psychiatric
Emergency Department
Specialty Practice - Radiology
Program Details
The Transition to Practice Program (TPP) is a 12-month program designed to provide the nurse resident with an opportunity to transition into the role of a professional nurse under the guidance and support of our clinical nursing staff, nurse educators and program facilitators.
The program includes didactic and simulated learning combined with hands-on training in the clinical practice based environment, facilitating the nurse resident's transition from novice to competent nurse. Additionally, the program aims to create a strong social network that fosters a sense of community, support, resiliency building and professional development.
The TPP is offered twice a year to newly-licensed graduate nurses from an accredited nursing program with a passion for children. All new graduates with less than one year of clinical experience are eligible to participate in the program after obtaining licensure.
Applications for the winter 2025 TPP will be available September 30, 2024 and applications for the summer 2025 program will be available January 13, 2025. The duration a position is posted is determined by response to the position. All positions will be posted for a minimum of two weeks.
Dialysis Nurse
Utilization review nurse job in Largo, MD
Job Title: RN Dialysis - Acute
Duration: 3 months with possible extension
Schedule: 3x12s, Day Shift
Hours per week: 37.5
Local Pay Rate: $72/hr
The Pay Rate Information:
Overall Weekly Pay: $2,964.61
Weekly Stipend: $1,914.61 (Non-Taxable)
W2 hourly Pay Rate: $28 (Taxable)
Requirements:
Associate degree in Nursing (A.D.N) - Required.
A state professional registered nurse license or multi-state compact license is required.
BLS is required.
At least one year of dialysis experience in the last five years is required.
Job Summary:
As an RN Dialysis Nurse, you will play a critical role in providing safe, high-quality care to patients undergoing dialysis treatment.
Monitoring patients before, during, and after dialysis sessions to ensure safety and comfort
Operating dialysis machines and managing vascular access sites
Administering medications and promptly addressing any complications or emergencies that arise during treatment
Educating patients on disease management, fluid restrictions, and lifestyle modifications to promote kidney health
MDS Nurse
Utilization review nurse job in Washington, DC
Are you an experienced nurse who wants to remain clinically involved in patient care without being a bedside nurse? Are you organized, efficient, and able to manage your own work with autonomy? MDS nursing at The Laurels of Salisbury may be just what you're looking for!
Laurel Health Care Company offers one of the leading employee benefit packages in the industry, including health insurance, 401K with matching funds, paid time off and paid holidays. When you work with Laurel Health Care Company, you will join an experienced, hard-working team that values communication and strong teamwork abilities.
Responsibilities:
The Care Management Nurse, MDS Nurse works the RAI process and conducts assessments and care plan coordination for those residents assigned. Some responsibilities of the MDS nurse include:
Completes the MDS, CAA's and care plans within regulated time frames.
Assesses resident through physical assessment, interview and chart review.
Discusses resident care needs with care givers, including physician, nursing, social services, therapy, dietary, and activity staff.
Reviews information from hospital, consults and outside agencies and uses such information in the completion of the assessment and care planning.
Coordinates, identifies, and/or initiates significant change MDS'
Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator
Remains current with the American Association of Nursing Assessment Coordinators (AANAC) requirements.
Qualifications:
Registered Nurse, RN or Licensed Practical Nurse
AANC certification a plus. RAC-CT
Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred.
Experience as an MDS Nurse
Laurel Health Care Company is a national provider of skilled nursing, subacute, rehabilitative, and assisted living services dedicated to achieving the highest standards of care.
We are a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana.
#IND123
REGISTERED NURSE-STAFF- RN- PART TIME- DAY/NIGHT SHIFT
Utilization review nurse job in Washington, DC
Sign-On Bonus Available Relocation Assistance Available Receive 17% Weekday Nights, 26% Weekend Nights and 15% Weekend Day shift differentials Full Time Shift: Days Work within the nursing process to provide direct nursing care to assigned patients. Serve as a role model to promote a positive work environment and quality patient care. Ensures adherence to Hospital and Departmental Policies and Procedures. Patient care assignment may include; Neonate, Pediatric, Adolescent, Adult and Geriatric age groups.
PATIENT CARE - Deliver safe direct care to an assigned group of patients as required
* POLICIES - Work within Hospitals, Nursing division and departmental policies
* CARE PLAN - Work in collaboration with the healthcare team, implement and document individualized care plans incorporating age specific considerations, including discharge planning and patient/family teaching
* upon successful completion of preceptor training assume precepting and evaluation responsibilities of new personnel
* EMERGENCY MEASURES - Assist with or institute emergency measures for sudden, adverse developments in patients
* MEDICAL RECORDS - Ensure that patient medical records contain necessary information
* INQUIRIES - Answer telephones and triage calls as per departmental policy
* document and communicate clinical findings
* PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols
* PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
* PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
* PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
* PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may "not seem right"
Program Graduate
Bachelor's Degree
Nationally Accredited Nursing Graduate
Nursing
No minimum experience required
Bilingual English/Spanish
CPR for Healthcare/BLS Prov or Prof Rescuers w/in 30 days
* RN in NM or as allowed by reciprocal agreement by NM
Chemicals, Bio Hazardous Materials req PPE
* Tuberculosis testing is completed upon hire and additionally as required
Registered Nurse
Utilization Management Nurse
Utilization review nurse job in Annapolis, MD
**Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others.
**Use your skills to make an impact**
**Required Qualifications**
+ Active unrestricted RN license with the ability to obtain Compact Nursing License
+ A minimum of three years clinical RN experience;
+ Prior clinical experience, managed care experience, **OR** utilization management experience
+ Demonstrates Emotional Maturity
+ Ability to work independently and within a team setting
+ Willing to work in multiple time zones
+ Strong written and verbal communication skills
+ Attention to detail, strong computer skills including Microsoft office products
+ Ability to work in fast paced environment
+ Ability to form positive working relationships with all internal and external customers
**Preferred Qualifications**
+ Education: BSN or bachelor's degree in a related field
+ Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
+ Previous experience in utilization management within Insurance industry
+ Previous Medicare Advantage/Medicare
+ Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.
+ Bilingual
**Alert**
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
**Interview Format - HireVue**
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**Work-At-Home Requirements**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**Benefits**
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-25-2025
**About us**
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
Easy ApplyUtilization Review Nurse (RN)
Utilization review nurse job in Towson, MD
When you come to the University of Maryland St. Joseph Medical Center, you're coming to more than simply a beautiful 37-acre, 218-bed suburban Baltimore, Maryland campus. You're embarking on a professional journey that encourages opportunities, values a team atmosphere, and makes convenience and flexibility a priority. Joining our team of healthcare professionals means you'll be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog Group as a grade ‘A' hospital and by U.S. News & World Report as #3 in both the state and Baltimore Metro area, making UM St. Joseph the highest-ranking community hospital in Maryland. In addition, we've been consistently recognized as a top employer by Baltimore magazine.
Job Description
Work Schedule * 8:00am - 4:30pm - Full time hybrid position with weekend rotation required.
The Utilization Review Nurse (RN) coordinates the care and service of selected patient populations across the continuum. He/ she works collaboratively with physicians and other members of the health care team to achieve the highest quality clinical outcomes with the most cost effective use of available resources. The Utilization Review Nurse (RN) assumes responsibility for an interdisciplinary process which assesses, plans, implements, monitors and measures the effectiveness of interventions to meet patients' treatment and transitional needs.
Qualifications
Education
* 2 year / Associate's Degree (Required)
* High School Diploma or GED (Required) 4 year / Bachelor's Degree (Preferred)
Certification / Licensure / Registration
*State Registered Nurse License (Required)
MCG Or InterQual experience (Preferred)
CCM Case Management Certification (Preferred) Experience and Skills
*2 - 4 years Familiarity with health care reimbursement systems (Required)
*4 - 6 years Acute care hospital or similar venue. (Required) 2 - 4 years Case management, discharge planning or utilization management (Preferred)
Required Skills: Strong Verbal Communications Skills, Strong Written Communications Skills, Excellent Interpersonal Skills, Medical Terminology
Additional Information
.All your information will be kept confidential according to EEO guidelines.
Compensation:
Pay Range: $39.52 - $50.65
Other Compensation (if applicable): N/A
Review the 2025-2026 UMMS Benefits Guide
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at [email protected].
HEDIS Clinical Medical Review Nurse
Utilization review nurse job in Rockville, MD
Job Title: Clinical Medical Review Nurse Type: Contract Compensation: $41.50 Contractor Work Model: Hybrid The Clinical HEDIS Nurse (Medical Review Specialist) is responsible for supporting the organization's HEDIS and Quality initiatives through medical record retrieval, clinical data abstraction, and quality review processes in alignment with NCQA specifications. This role demands significant expertise in HEDIS measures, EMR navigation, and clinical abstraction. The nurse must maintain strict adherence to HIPAA Privacy and Security standards and demonstrate a strong commitment to data accuracy, quality improvement, and timely execution.
Candidates must hold an active RN or LPN license.
Work Arrangement
This is a hybrid role, with a combination of remote work and potential on-site requirements based on operational needs.
Key Responsibilities
+ Contact provider offices to request or validate facility and provider contact information specifically for HEDIS medical record retrieval.
+ Retrieve and upload medical records from electronic medical record (EMR) systems in accordance with HIPAA requirements and HEDIS guidelines.
+ Abstract clinical data from medical charts accurately and efficiently using proprietary abstraction platforms and following company-specific training and NCQA specifications.
+ Use internal systems to create, track, and research clinical and retrieval pends to support overall HEDIS operations.
+ Document all communications, record retrieval activities, and chart status updates in designated systems.
+ Assist with outreach and coordination efforts to maximize medical record collection efficiency and compliance.
Additional Responsibilities (assigned based on experience and skill set)
Overreading:
+ Review and validate abstracted charts completed by other team members for accuracy and adherence to HEDIS guidelines.
+ Correct errors identified during overread and conduct additional chart reviews when similar errors are found.
+ Collaborate with abstractors to provide feedback and re-education when necessary.
Risk Adjustment & Off-Season Support:
+ Support medical record retrieval activities for risk adjustment, supplemental data validation (PSV), and various other quality and HEDIS-related initiatives outside of the core season.
Qualifications
Education:
+ Degree in Nursing (Associate's, Diploma, or Bachelor's)
+ Credentials such as RHIA, RHIT, or a related field preferred
Licensure:
+ Active RN or LPN license is required
Experience:
+ At least 3 years of clinical nursing experience
+ Minimum of 5 years of HEDIS experience in a health plan or vendor setting
+ Strong understanding of NCQA quality metrics
+ Experience with HEDIS abstraction software or tools (e.g., Reveleer, Cotiviti, Inovalon) preferred
Technical Skills:
+ Proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook, Teams)
+ Experience with multiple EMR systems, including Epic, eClinicalWorks, Athena, Cerner, AllScripts, and Tebra
Core Competencies:
+ Strong attention to detail and analytical thinking
+ High degree of accuracy in data interpretation and entry
+ Excellent time management and organizational skills
+ Ability to work independently and collaboratively in a fast-paced environment
+ Professional communication skills, both written and verbal
Work Environment
+ Hybrid work model (remote and occasional in-office work as needed)
+ Requires prolonged periods of sitting and working on a computer
+ Frequent phone interaction with provider offices may be required
System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
#M2
#LI-AJ1
#DI-
Ref: #850-Rockville (ALTA IT)
System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
Formulary Strategy & Utilization Review Pharmacist
Utilization review nurse job in Washington, DC
Formulary Strategy & Utilization Review Pharmacist
Shape the drug benefit landscape-analyze and optimize medication use.
Key Responsibilities:
Review prescribing trends and propose cost-saving alternatives.
Maintain evidence-based formularies across multiple payers.
Conduct retrospective DUR and prepare stakeholder reports.
Qualifications:
PharmD with managed care, DUR, or pharmacy benefit experience.
Strong Excel/data analytics background preferred.
Understanding of clinical guidelines and P&T processes.
Why Join Us?
Join a top-tier managed care team
Hybrid flexibility
Strategic and data-driven focus
Utilities & Permits Coordinator
Utilization review nurse job in Annapolis, MD
Schaefer Homes
Utilities & Permits Coordinator
Schaefer Homes is more than a construction company -- we're a dream factory for families building the place they'll call home. We're a fast-growing, highly reputable production builder in Maryland. Our edge is simple: quality work, strong processes, and a customer experience that's personal and dependable.
We're looking for a Utilities & Permits Coordinator who can keep projects moving by managing permits end-to-end, coordinating gas and electric services, and helping drive our starts pipeline from "paper ready" to "shovel ready." If you're organized, proactive, and know how to work with counties, cities, and utility providers without letting things stall, this role will fit you well.
What You'll Do
Permits & Approvals
Provide direct oversight of all permit functions across our projects.
Prepare, process, submit, and track permit applications through the full permit cycle.
Monitor all upcoming and in-progress projects to ensure timely submissions and approvals.
Coordinate permit needs with internal departments (construction, land, sales, design, etc.).
Serve as a primary point of contact for permit status, updates, and inquiries.
Coordinate with county/city agencies to obtain all required permits and approvals.
Review and interpret zoning ordinances, land division regulations, and jurisdictional policies impacting real estate and right-of-way work.
Ensure all permitting activities meet company standards, client expectations, and regulatory requirements.
Maintain accurate, organized documentation and databases for active permits and submissions.
Track certificates of insurance, performance bonds, and any compliance-related documents tied to permitting.
Utilities Coordination (Gas & Electric Only)
Coordinate gas and electric utility services for all projects.
Work directly with utility providers to ensure timely, accurate service installation and activation.
Review gas and electric plans/drawings to confirm requirements and field alignment.
Track schedules, outages, relocations, and inspections tied to gas/electric service.
Monitor progress of installations and report the status to project teams.
Maintain clear, organized records of all gas and electric coordination activity.
Support and coordinate with any staff assisting in utility scheduling and follow-through.
Conduct site visits as needed to confirm gas/electric needs and verify installations.
Starts Process Coordination
Coordinate and track each home through our start process, ensuring all permit and utility requirements are complete before release to construction.
Maintain visibility on upcoming starts and communicate clear timelines to construction, land, and scheduling teams.
Flag risks early (missing docs, agency delays, utility lead times, plan conflicts) and push solutions before they impact start dates.
Run consistent follow-up with internal teams and external agencies to keep starts on schedule.
Keep starts documentation clean and current so leadership always knows what's ready, what's pending, and what's blocked.
What We're Looking For
Prior experience coordinating permits and/or gas/electric utilities in residential construction or land development.
Strong working knowledge of Maryland county/city permitting processes and utility coordination.
Ability to read and interpret zoning/utility plans and regulatory requirements.
Excellent organizational skills and follow-through -- you don't drop the ball.
Clear communicator who can push issues forward with agencies, utilities, field teams, engineers, attorneys, and landowners.
Comfortable juggling multiple projects at once without losing timelines or details.
Proficient in maintaining databases, tracking logs, and documentation systems.
Compensation:
$65,000 - $75,000 based on experience
Additional Bonus Program
Why Schaefer Homes
We don't just build houses -- we build homes that families grow into. That means our standards are high and our timelines matter. You'll be trusted to own your lane, remove roadblocks, and keep projects moving. If you want real responsibility and a team that values good process and good people, you'll find that here.
Nurse Case Mgr II (US)
Utilization review nurse job in Washington, DC
Nurse Case Manager II
Location: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Nurse Case Manager II will be responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.
How you will make an impact:
Ensures member access to services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures.
Minimum Requirements:
Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in applicable state(s) required (Washington, DC).
Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities and Experiences:
Certification as a Case Manager is preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $84,272- $126,408
Locations: District of Columbia (Washington, DC)
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws
.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyNurse Case Mgr I (US)
Utilization review nurse job in Washington, DC
Nurse Case Manager I Location: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Schedule: Monday-Friday 8:00AM-5:00PM or 8:30AM-5:30PM EST
The Nurse Case Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.
How you will make an impact:
* Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
* Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
* Coordinates internal and external resources to meet identified needs.
* Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
* Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
* Negotiates rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues.
Minimum Requirements:
* Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
* Current, unrestricted RN license in applicable state(s) required.
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities & Experiences:
* Certification as a Case Manager and a BS in a health or human services related field preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $75,440 - $113,160
Locations: District of Columbia (Washington, DC)
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyTravel Outpatient BMT Nurse Coordinator - $2,433 per week
Utilization review nurse job in Washington, DC
PRIDE Health is seeking a travel nurse RN Hematology / Oncology for a travel nursing job in Washington, District of Columbia.
Job Description & Requirements
Specialty: Hematology / Oncology
Discipline: RN
Duration: 13 weeks
40 hours per week
Shift: 8 hours, days
Employment Type: Travel
Pride Health Job ID #17525814. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Bone Marrow Oncology,09:00:00-17:00:00
About PRIDE Health
PRIDE Health is the minority-owned healthcare recruitment division of Pride Global-an integrated human capital solutions and advisory firm. With our robust and abundant travel nursing and allied health employment options across the U.S., PRIDE Health will allow you to help change the way the world lives and heals as it connects you with the industry's leading healthcare organizations.
Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.
Benefits
Weekly pay
Holiday Pay
Guaranteed Hours
401k retirement plan
Cancelation protection
Referral bonus
Medical benefits
Dental benefits
Vision benefits
Travel Outpatient BMT Nurse Coordinator - $2,261 per week
Utilization review nurse job in Washington, DC
Prime Staffing is seeking a travel nurse RN Hematology / Oncology for a travel nursing job in Washington, District of Columbia.
Job Description & Requirements
Specialty: Hematology / Oncology
Discipline: RN
Duration: 13 weeks
40 hours per week
Shift: 8 hours
Employment Type: Travel
About the Position
Specialty: RN - Psych
Experience: 1-2 years in psychiatric or behavioral health nursing preferred
License: Active State or Compact RN License
Certifications: BLS - AHA
Must-Have: Strong crisis intervention skills, ability to manage behavioral emergencies
Description: The Psychiatric RN provides direct care to patients with mental health or substance use disorders. Responsibilities include conducting assessments, administering medications, implementing care plans, supporting therapeutic activities, and ensuring a safe environment. Collaborates closely with behavioral health teams and maintains accurate patient documentation.
Requirements
Required for Onboarding:
Active RN License
BLS
CPI or PMAB (as applicable)
Prime Staffing Job ID #35127191. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Psych,08:00:00-16:00:00
About Prime Staffing
At Prime Staffing, we understand the importance of finding the perfect fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent staffing to our clients, and the most competitive contracts to our workforce. Our experienced team takes the time to get to know both our clients and candidates, their needs, and preferences, to ensure that each placement is a success.
We offer a wide range of staffing services including temporary, temp-to-perm, and direct hire placements. Our extensive network of qualified candidates includes nurses, allied healthcare professionals, corporate support professionals and executives.
Nurse Care Coordinator RN, Baltimore City, Md (CCBHC, Full Time, Day Shift)
Utilization review nurse job in Baltimore, MD
Performs a full range of professional nursing services, including assessing, planning, and evaluating patient care in accordance with the team treatment plan. Administers treatment as prescribed by physician and is responsible for teaching and providing psychosocial support to patients. Facilitates coordination of care while monitoring treatment adherence. Documents and reports patient status and progress to treatment team.
Responsibilities:
Actively seek to provide quality services that meet the needs of patients as well as other clients, families, payers, referrers, and staff. Provide consultation, instruction, and direction to other clinical staff, students, and volunteers.
Interview patients and will assess their functional level according to professional standards. Provide pre-admission screening as is required.
Help to develop a professional treatment plan that meets patient needs and complements the services provided by other treatment teams.
Provide professional nursing care to individuals and groups based on an understanding of the special needs of the patient population served. Performs medical treatments as prescribed by a physician or as is indicated by the patient's condition. Recognize common alterations in patient physiological and psychological status; initiates action as indicated to provide safe and therapeutic treatment. Instructs patients and families on mental health issues, treatments, procedures, plans of care, home care methods and techniques that are necessary for continuing patient care and rehabilitation.
Complete written documentation of initial patient assessment and ongoing treatment and progress through discharge in compliance with program standards. Reports pertinent patient observations to treatment team.
Participate in the evaluation of program effectiveness and efficiency and works to ensure continuous improvements in the quality of services.
Requirements:
Knowledge on nursing theory, principles, and practice-a normally acquired through graduation of an accredited program of Nursing and/or 2-3 years of direct job related experience.
Possession of a current license as a Registered Nurse in the State of Maryland at the time of appointment. Maintains professional knowledge and skills through attendance to professional meetings, workshops, courses, and in-service sessions.
Analytical ability and sound nursing knowledge for the effective formulation of nursing care plans, implementation of care, and appropriate documentation of pertinent information regarding a patient's condition.
Excellent interpersonal skills and the ability to interact effectively with psychiatrically ill patients in order to gain their cooperation, allay apprehensions and provide effective health education to patients and family members.
Ability to physically intervene in medical and behavioral emergencies, transport patients, and assist in the lifting of a patient.
What you'll get from us.
At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:
A commitment to professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
Comprehensive medical, dental and vision benefits for benefit eligible positions
403b retirement match
Generous paid-time-off for benefit eligible positions
Complimentary Employee Assistance Program (EAP)
Generous mileage reimbursement program
The pay range for this position is $74,263 minimum to $81,954.53 maximum. Pay for this position is determined on a number of factors, including but not limited to, years and level of related experience.
WHY SHEPPARD PRATT?
At Sheppard Pratt, we are more than just a workplace. We are a community of healthcare professionals who are dedicated to providing hope and healing to individual's facing life's challenges. Join us and be a part of a mission that changes lives!
#LI-BT1
#IND123
Travel Outpatient BMT Nurse Coordinator - $2,375 per week
Utilization review nurse job in Washington, DC
Coast Medical Service is seeking a travel nurse RN Hematology / Oncology for a travel nursing job in Washington, District of Columbia.
Job Description & Requirements
Specialty: Hematology / Oncology
Discipline: RN
Start Date: 02/09/2026
Duration: 13 weeks
40 hours per week
Shift: 8 hours, days
Employment Type: Travel
Coast Medical Service is a nationwide travel nursing & allied healthcare staffing agency dedicated to providing an elite traveler experience for the experienced or first-time traveler. Coast is featured on Blue Pipes' 2023 Best Travel Agencies and named a 2022 Top Rated Healthcare Staffing Firm & 2023 First Half Top Rated Healthcare Staffing Firm by Great Recruiters. Please note that pay rate may differ for locally based candidates. Please apply here or contact a recruiter directly to learn more about this position & the facility, and/or explore others that may be of interest to you. We look forward to speaking with you!
Coast Medical Services Job ID #35127223. Pay package is based on 8 hour shifts and 40.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:Bone Marrow,07:00:00-15:30:00
Benefits
Holiday Pay
Sick pay
401k retirement plan
Pet insurance
Health Care FSA
Utilization Management Nurse
Utilization review nurse job in Washington, DC
**Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others.
**Use your skills to make an impact**
**Required Qualifications**
+ Active unrestricted RN license with the ability to obtain Compact Nursing License
+ A minimum of three years clinical RN experience;
+ Prior clinical experience, managed care experience, **OR** utilization management experience
+ Demonstrates Emotional Maturity
+ Ability to work independently and within a team setting
+ Willing to work in multiple time zones
+ Strong written and verbal communication skills
+ Attention to detail, strong computer skills including Microsoft office products
+ Ability to work in fast paced environment
+ Ability to form positive working relationships with all internal and external customers
**Preferred Qualifications**
+ Education: BSN or bachelor's degree in a related field
+ Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
+ Previous experience in utilization management within Insurance industry
+ Previous Medicare Advantage/Medicare
+ Current nursing experience in Hospital, SNF, LTAC, DME or Home Health.
+ Bilingual
**Alert**
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
**Interview Format - HireVue**
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**Work-At-Home Requirements**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**Benefits**
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-25-2025
**About us**
About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
Easy ApplyNurse Case Mgr II (US)
Utilization review nurse job in Washington, DC
**Nurse Case Manager II** **Location:** **Washington, DC.** This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The **Nurse Case Manager II** will be responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.
**How you will make an impact:**
+ Ensures member access to services appropriate to their health needs.
+ Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
+ Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
+ Coordinates internal and external resources to meet identified needs.
+ Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
+ Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
+ Negotiates rates of reimbursement, as applicable.
+ Assists in problem solving with providers, claims or service issues.
+ Assists with development of utilization/care management policies and procedures.
**Minimum Requirements:**
+ Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
+ Current, unrestricted RN license in applicable state(s) required (Washington, DC).
+ Multi-state licensure is required if this individual is providing services in multiple states.
**Preferred Skills, Capabilities and Experiences** :
+ Certification as a Case Manager is preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $84,272- $126,408
Locations: District of Columbia (Washington, DC)
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Nurse Coordinator - Co-Ed Adolescent Mood Disorders & Adolescent Female Inpatient Unit-Towson, Full Time
Utilization review nurse job in Towson, MD
between two inpatient units.
The Co-Ed Adolescent Mood Disorder Unit is for the multi-disciplinary assessment, evaluation, crisis intervention, and stabilization of adolescent female and male patients. Discharge planning emphasizes movement to day hospital or outpatient care as soon as the crisis has been stabilized.
The Adolescent Female Crisis Stabilization Unit is a 22 bed unit for the multi-disciplinary assessment, evaluation, crisis intervention, and stabilization of adolescent female patients. Discharge planning emphasizes movement to day hospital or outpatient care as soon as the crisis has been stabilized.
What to expect.
Communicates in a therapeutic, respectful way with patients at the patients' level of understanding.
Investigates and follows up on complaints or concerns from patients' family members.
Assigns inpatient rooms based on requirements of programming tracks on inpatient unit(s).
Reassigns nursing staff as necessary to provide optimum coverage and regulatory/compliance requirements.
Manages milieu and operational concerns on unit(s).
Assists and provides direction to nursing staff in resolving problems.
Apprises nurse leader of concerns that require her/his attention.
In the absence of or as delegated by the nurse leader, assesses and coordinates the resolution of clinical crises.
Provides significant input into the procedures and protocols for the unit
Provides support to nurse leader by interviewing and screening candidates for existing nursing vacancies.
Orients new nursing staff to the unit.
Maintains appropriate documentation regarding new employee and ongoing education and training, competency assessment and performance appraisal, working with Human Resources as needed.
Identifies nursing staff education needs and recommends methods of staff development to nurse leader.
Provides input into the performance appraisals of RNs, mental health workers and unit support staff
Utilizes clinical expertise in the provision of direct patient care as needed, consultative activities, staff development, and treatment planning.
Provides quality nursing care services that are based on an understanding of the needs of the assigned patient population
Assists nurse leader in evaluating and monitoring nursing documentation and initiates corrective action to ensure compliance with internal and external standards
Helps create a culture of performance improvement that contributes to providing quality, cost effective services.
Suggests ways in which the unit/program can maintain and improve safety.
Attends required in-services for updates and reviews.
Maintains confidentiality with regard to all communication pertaining to patients, families and organizational business.
Other duties as assigned.
What you'll get from us.
At Sheppard Pratt, you will work alongside a multi-disciplined team led by a bold vision to change lives. We offer:
An extended clinical orientation led by Sheppard Pratt's Clinical Education Department to prepare you for the responsibilities of your role.
A commitment to professional development, including a comprehensive tuition reimbursement program to support ongoing education and licensure and/or certification preparation
Comprehensive medical, dental and vision benefits for benefit eligible positions
403b retirement match
Generous paid-time-off for benefit eligible positions
Complimentary Employee Assistance Program (EAP)
Generous mileage reimbursement program
The pay range for this position is $85,404.80 minimum to $140,753.60 maximum. Pay for this position is determined on a number of factors, including but not limited to, board certifications and years and level of related experience.
What we need from you.
Work requires graduation from an accredited program of nursing (BSN preferred) and possession of a current license as a Registered Nurse in the State of Maryland at the time of appointment and continuously while in position.
Work requires clinical and managerial skills, knowledge of psychiatric nursing, and comprehensive knowledge of diagnosis and treatment of assigned patient population - acquired through two to three years of related experience, 1 of which must be in inpatient psychiatric nursing.
Work requires interpersonal skills sufficient to provide effective leadership for assigned personnel and to interact effectively with psychiatrically and physically ill patients, family members, visitors and a variety of Sheppard Pratt departments (51 to 80% of work time).
Work requires analytical and problem-solving abilities necessary to reassign nursing staff to meet programming demands of unit; screen applicants (with supervision of nurse leader); identify training needs; and resolve nursing and administrative issues in absence of the nurse leader.
In keeping with the Maryland Board of Nursing guidelines, all nurses must have an active Maryland nursing license to practice in the state of Maryland, or must have an active license in a compact state that allows them to practice in Maryland, if they reside in that compact state. A multistate licensee who changes primary state of residence to another party state shall apply for a multistate license in the new party state within 60 days. The rule requires that a nurse apply for a new license in a new primary state of residence within 60 days of relocating, it does not require the new license be issued within 60 days.
#LI-SH1
Nurse Case Manager PRN
Utilization review nurse job in Bel Air, MD
University of Maryland Upper Chesapeake Health (UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience.
A community-based, integrated, non-profit health system, our vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We are dedicated to maintaining and improving the health of the people in our community through an integrated health delivery system that provides high quality care to all. Our commitment to service excellence is evident through a broad range of health care services, technologies and facilities. We work collaboratively with our community and other health organizations to serve as a resource for health promotion and education.
Today, UM UCH is the leading health care system and second largest private employer in Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern Baltimore County, and western Cecil County.
University of Maryland Upper Chesapeake Health owns and operates:
University of Maryland Upper Chesapeake Medical Center (UM UCMC), Bel Air, MD
The Upper Chesapeake Health Foundation, Bel Air, MD
The Patricia D. and M. Scot Kaufman Cancer Center, Bel Air, MD
The Senator Bob Hooper House, Forest Hill, MD
Job Description
JOB SUMMARY: Provides Care Coordination and discharge planning services for all inpatients accessing care through the Univ. of Md. Upper Chesapeake Health. Completes psychosocial assessments, assists with treatment planning, monitors patient progress, facilitates patient and family meetings, and
coordinates and implements discharge services. Screens patients to identify anticipated needs, interacts
with patients and families, so that a safe and timely care plan is achieved. Coordinates and implements
discharge and post-acute services for inpatient caseload. Position requires some coverage of holiday and weekend shifts. May interact with clients or customers ranging in age from newborn
to geriatric.
Qualifications
Education & Training: Currently licensed as an RN in the State of Maryland. Associate's degree or diploma in Nursing required. Completion of a Bachelor's of Science degree in Nursing preferred.
Work Orientation & Experience: Acute care nursing experience required. Inpatient or Outpatient care experience required. Case Management experience preferred.
Skills & Abilities: Demonstrate skill in a) clinical case management; b) performing complete assessments; c) effective critical thinking skills both written and oral; and d) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult.) Ability to a) communicate and collaborate effectively with both internal and external customers (colleagues, Medical Staff, liaisons, and patient/family); b) assess, adapt, and calmly respond to changing and/or crisis environment; c) make independent decisions consistent with current policies, procedures, and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) assist in data analysis.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Compensation:
Pay Range: $42.64 - $64.00
Other Compensation (if applicable): n/a
Review the 2025-2026 UMMS Benefits Guide
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at [email protected].
Nurse Case Manager
Utilization review nurse job in Bel Air, MD
University of Maryland Upper Chesapeake Health (UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience.
A community-based, integrated, non-profit health system, our vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We are dedicated to maintaining and improving the health of the people in our community through an integrated health delivery system that provides high quality care to all. Our commitment to service excellence is evident through a broad range of health care services, technologies and facilities. We work collaboratively with our community and other health organizations to serve as a resource for health promotion and education.
Today, UM UCH is the leading health care system and second largest private employer in Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern Baltimore County, and western Cecil County.
University of Maryland Upper Chesapeake Health owns and operates:
University of Maryland Upper Chesapeake Medical Center (UM UCMC), Bel Air, MD
The Upper Chesapeake Health Foundation, Bel Air, MD
The Patricia D. and M. Scot Kaufman Cancer Center, Bel Air, MD
The Senator Bob Hooper House, Forest Hill, MD
Job Description
JOB SUMMARY: Provides Care Coordination and discharge planning services for all inpatients accessing care through the Univ. of Md. Upper Chesapeake Health. Completes psychosocial assessments, assists with treatment planning, monitors patient progress, facilitates patient and family meetings, and
coordinates and implements discharge services. Screens patients to identify anticipated needs, interacts
with patients and families, so that a safe and timely care plan is achieved. Coordinates and implements
discharge and post-acute services for inpatient caseload. Position requires coverage on holidays and on
back- up call system on weekends. May interact with clients or customers ranging in age from newborn
to geriatric.
Qualifications
Education & Training: Currently licensed as an RN in the State of Maryland. Associate's degree or diploma in Nursing required. Completion of a Bachelor's of Science degree in Nursing preferred.
Work Orientation & Experience: Acute care nursing experience required. Inpatient or Outpatient care experience required. Case Management experience preferred.
Skills & Abilities: Demonstrate skill in a) clinical case management; b) performing complete assessments; c) effective critical thinking skills both written and oral; and d) age appropriate interpersonal interactions (patients may range from newborn to geriatric adult.) Ability to a) communicate and collaborate effectively with both internal and external customers (colleagues, Medical Staff, liaisons, and patient/family); b) assess, adapt, and calmly respond to changing and/or crisis environment; c) make independent decisions consistent with current policies, procedures, and ethical standards; d) prioritize work assignments and manage time effectively to complete duties; and e) assist in data analysis.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Compensation:
Pay Range: $42.64 - $57.77
Other Compensation (if applicable): n/a
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