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.
Utilization 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].
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 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 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.
Nurse 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.
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
Fertility (RN) Nurse Coordinator
Utilization review nurse job in York, PA
Enjoy what you do while contributing to a company that makes a difference in people's lives. Shady Grove Fertility, one of the premier fertility centers in the United States, continually seeks experienced, compassionate, and dynamic team players who are committed to delivering exceptional patient care to join our growing practice. The work we do, building families, offers stimulation, challenge, and personal reward.
If you're a Registered Nurse looking for a new opportunity to work in a fast-paced, professional environment where your talent contributes to changing people's lives, then we want to talk to you. This position requires collaborating with physicians, other medical providers, and patients by providing nurse case management services for fertility treatments.
We are seeking a full-time Fertility RN Coordinator to join our York PA office. The schedule is working Monday through Friday, daytime hours, 7:00am - 4:00pm with occasional weekend/holiday shifts.
How You'll Contribute:
We always do whatever it takes, even if it isn't specifically our "job." In general, the Fertility RN Coordinator is responsible for:
Assisting with the coordination, case management, and treatment of our fertility patients
Providing patient/couple counseling
Teaching about procedures and how to administer injections
Scheduling treatment after initial and follow up visits
Coordinating patient treatment plans in conjunction with established clinical protocols
Establishing a compassionate environment by providing emotional and psychological support to patients and patients' families
Required to work occasional weekends and holidays
What You'll Bring:
IVF/fertility experience and background in women's health a plus; training will be provided
Valid RN license
Experience working with electronic medical records a must
High level of customer service essential and must be a self-starter
A minimum of 1 year of experience in a clinical RN position
More important than the best skills, however, is the right person. Employees who embrace our mission, vision, and core values are highly successful.
What We Offer:
Full-Time Employees (30+ hours/week):
Medical, dental, and vision insurance, 401(k) with company match, tuition assistance, performance-based bonus opportunities, generous paid time off, and paid holidays
Part-Time Employees:
401(k) with company match and performance-based bonus opportunities
Per Diem Employees:
401(k) with company match
At Shady Grove Fertility, we promote and develop individual strengths in order to help staff grow personally and professionally. Our core values - Empathy, Patient Focus, Integrity, Commitment, and Compassion (EPICC) - guide us daily to work hard and enjoy what we do. We're committed to growing our practice and are always looking to promote from within. This is an ideal time to join our team!
To learn more about our company and culture, visit here.
How To Get Started:
To have your resume reviewed by someone on our Talent Acquisition team, click on the “Apply” button. Or if you happen to know of someone who might be interested in this position, please feel free to share the job description by clicking on an option under “Share This Job” at the top of the screen.
Post-Acute NP/PA - Full time in Northern, MD region!
Utilization review nurse job in Westminster, MD
Our Post-Acute team provides medical services for various Skilled Nursing, Rehabilitation, Long Term Care and Assisted Living facilities.
Deliver compassionate patient care working on our growing post-acute care team.
Essential Job Functions:
Competently perform exams and complete assessments and treatment plan.
Adhere to Adfinitas policies for frequency of overseeing the care of and reviewing the notes related to specific episodes of care for patients of the skilled nursing facility.
Facilitate the patient's transition within and between health care settings, e.g. admitting, transferring, and discharging patients.
Collaborate with multidisciplinary team members.
Submit accurate and timely charges for all professional services performed
REQUIREMENTS
1+ years of experience as an Advanced Practice Provider in an acute role, preferably long-term care or skilled nursing facility or similar inpatient experience required
Graduate of an accredited school and program, respective to role (PA-C, or NP)
Licensure to practice medicine in good standing, with the state governing body
Federal DEA certification in good standing
State CDS in good standing
Capable of being successfully credentialed at designated locations
Possess strong clinical skills and demonstrate competency in providing comprehensive health care including evaluation, diagnosis and treatment
Flexibility and organizational skills to work autonomously
Proven skills, knowledge base, and judgment necessary for independent clinical decision making
Excellent organizational, time management and problem-solving skills
Ability to function effectively as part of a multi-disciplinary team
Effective oral and written communication skills
Demonstrate commitment to high ethical standards and healthcare compliance.
Ability to work in stressful situations.
Strong computer skills, including various EMR systems.
ABOUT US - ADFINITAS HEALTH
Adfinitas Health is a rapidly growing and multispecialty medical practice. Founded in 2007, we are a physician-owned and managed company, providing high-quality, cost-effective clinical management services across the full continuum of care in hospitals, critical care and post-acute facilities.
We recruit and train the best and brightest medical professionals and offer career advancement, leadership training and education, and the ability to practice at the top of one's license. Our physicians, nurse practitioners, and physician assistants are supported by a dedicated team of business professional to ensure that the administrative and operational components of care are properly managed - allowing our providers to focus on patient care and quality improvement.
BENEFITS FOR FULL TIME
Competitive salary and bonus package
Comprehensive benefits including Health, dental, vision, CME, 401k, ST/LT disability and life insurance
Paid Time Off
Leadership and training programs available
Malpractice insurance with tail, 100% company paid
Cross-training opportunities
Incentives for improved productivity and quality care
Manageable caseloads
Flexibility in scheduling
Recognition of service outside of work
We offer flexibility and work-life balance.
Adfinitas Health is a government contractor and an Equal Opportunity/Affirmative Action Employer. It is Adfinitas Health's policy that all personnel-related decisions are made without regard to race, color, religion, sex, national origin, age, disability, marital or veteran status, or any other protected status.
Admissions Enrollment for Nursing & Healthcare Professions
Utilization review nurse job in Washington, DC
Enrollment Admissions Recruiter for The School of Nursing & Healthcare Professionals (NHP)
Salary Range 65k to 80k (Annually)
Trinity Washington University seeks an Enrollment Admissions Recruiter for the School of Nursing and Health Professions (NHP) who is sales driven and has knowledge of the healthcare system. This role will build credible relationships among prospective students, families, health care and medical professionals, and community partners, that yield enrollment results. The successful candidate will have healthcare knowledge with previous sales experience, superior interpersonal skills, a commitment to the mission of Trinity, and an understanding of the market. The Enrollment Admissions Recruiter will diligently manage a portfolio of passionate prospects, from inquiry through enrollment working collaboratively with Enrollment Services (Financial Aid, Advising, Student Success, and other offices as needed). The successful candidate will possess a genuine enthusiasm for recruitment work, deploy a creative and personable sales approach, and understand the value of professional collaboration within a student-centered environment.
The Enrollment Admissions Recruiter for NHP will recruit and support enrollment goals for new student growth among undergraduate and graduate students. Work closely with a team of highly capable professionals, all committed to the mission of the institution. Desirable candidates will be able to effectively communicate and demonstrate their successful record of relationship management, sales, and stakeholder engagement. Trinity seeks team members with strong communication talents, and an eagerness to develop new relationships as needed to support growth opportunities for the University.
This position will report to the Director of Admissions for NHP, and will work collaboratively with Deans and the Associate Vice President of Admissions for Graduate & Professional Schools.
About Trinity:
Located in the Nation's Capital, Trinity Washington University is a premier, private institution founded in 1897 with 127 years of educational excellence and catholic tradition designed for undergraduate women with graduate, professional, and certificate academic programs for all.
Primary Responsibilities:
Recruit, steward, and enroll undergraduate and graduate students in the School of Nursing and Health Professions program.
Build and manage constituent relationships with healthcare facilities, hospitals, rehabilitation centers, community partners, and community colleges.
Develop and execute yield events as needed for the targeted enrollment pipelines.
Use data to track enrollment analytics and target efforts for outreach.
Produce and provide compelling presentations for multiple constituents to support enrollment growth.
Travel to recruitment events (locally and within a nearby radius) to recruit prospective students; actively participate in recruitment events held in person on campus and virtually.
Prepare weekly admission reports.
Characteristics of successful candidates:
Possess knowledge of the healthcare system
Strong sales & marketing orientation with demonstrated results
Have strong presentation skills
Ethical, adhering to high standards of integrity
Capable of using data to direct focus/efforts
Excellent oral and written communication skills
Able to develop a network of relevant relationships
Collaborative/Positive team player
Highly creative with strong problem-solving skills
Commitment to Trinity's mission and strategic goals
Bilingual proficiency is highly desired (Spanish)
Qualifications:
A bachelor's degree is required, Master's degree, is preferred.
At least 2 years of successful professional sales-related experience in healthcare is required, College Admissions recruitment experience is preferred.
Ability to work a flexible schedule, including evenings and weekends as needed.
This position requires driving a personal vehicle on behalf of the university; therefore, the incumbent must possess and maintain a current, valid driver's license. Trinity reimburses mileage and travel expenses.
Trinity offers comprehensive and competitive benefits to full-time employees to include Health, Dental & Vision insurance, Employer Paid Life and Disability benefits, 403(b) Retirement plan with employer match up to 6%, Paid Family Leave, Trinity Center Membership Free to all employees to include full size pool, walking track, weight & Cardio equipment, Free campus parking, Free Shuttle bus between campus & Brookland Metro station and more.
Trinity Washington University is dedicated to the achievement of excellence and diversity among its students, faculty and staff. Trinity is committed to fostering a diverse and inclusive community and strongly encourages all qualified individuals to apply.
Auto-ApplySummer Camps Nurse
Utilization review nurse job in Bel Air, MD
Job Title Summer Camps Nurse Posting Category Part-Time Staff Starting salary range or starting hourly rate range $3,851 paid over duration of season Classification Title About Harford Community College Harford Community College (HCC) has been a vital part of Harford County since 1957. As a mid-sized, comprehensive institution, we're committed to delivering high-quality education and cultural enrichment to our community. Our mission is to provide relevant, accessible education and training that connects individuals to opportunities in an ever-evolving world. As an Achieving the Dream institution, HCC is part of a national network dedicated to enhancing student success in community colleges. To learn more about our vision and values, visit our website.
Affirmative Action and Equal Employment Opportunity Statement
Harford Community College is committed to the principles of Affirmative Action and Equal Employment Opportunity. It is the policy of Harford Community College not to discriminate against applicants on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status, or any other characteristic protected by law with regard to any employment practices. HCC is an EEO and ADA/ADAA employer, including disability and protected veteran status.
Benefits Job Description
Harford Community College is currently seeking a part-time Summer Camps Nurse for our Summer Youth Camps. Camp season begins June 22, 2026, and continues through August 14, 2026.
The Summer Camps Nurse will serve as the Health Supervisor for HCC Summer Youth Camps, administering and maintaining the summer camp health program. The Health Supervisor is required to be on campus while camps are in session to support, as needed, any medical needs such as asthma, cancer, diabetes, or epilepsy.
Essential Duties and Responsibilities:
* Review and approve the summer camps' health program.
* Train and collaborate with campus staff to serve as Health Supervisor Designees in their absence, providing simple first aid and overseeing self-administered medication by campers.
* Maintain health records for campers and staff, and keep a daily log of health or safety incidents as needed.
* Develop a plan of action for campers identified with behavioral or medical needs.
* Manage medical supplies and oversee the distribution of first aid supplies to every classroom at the beginning of each camp.
* Ensure all campers have completed necessary medical forms before attending camp.
* Follow up with parents regarding incomplete or missing medical forms.
* Perform other duties as assigned by the supervisor.
The Summer Camps Nurse is required to attend employee training, to be scheduled for the week of June 8th.
Employees of Harford Community College, including instructors for online and virtual courses, must be residents of Maryland or the contiguous states of Delaware, Pennsylvania, Virginia, West Virginia, or the District of Columbia.
Applicants must be currently authorized to work in the United States, as the College does not offer Visa sponsorship for this position.
Required Education
Must be a registered nurse licensed and able to currently practice in the state of Maryland.
Required Experience
Previous experience in a camp or pediatric setting preferred.
Required Knowledge, Skills, & Abilities
* Ability to successfully pass an FBI, MD, and CJIS background screening.
* First Aid and CPR/AED certified - HCC offers two free classes to summer camp employees prior to the beginning of camp, dates to be determined.
* Must be able to work in a camp environment, which may include outdoor activities and varying weather conditions.
* Strong customer service skills
* Excellent communication skills.
* Ability to work and cooperate with co-workers and supervisors at all levels.
* Ability to work with, within, and promote a diverse workforce and environment.
* Ability to understand and act on oral and written instructions in English.
* Ability to learn and perform all essential job functions accurately.
Preferred Qualifications
June 22, 2026 to August 14, 2026 availability preferred or at least 4 weeks total availability; conflicts with availability or requested leave time must be submitted at the time of hire for approval.
General Weekly Work Schedule
The work schedule is approximately 20 hours per week. Schedules will vary between 8:30 a.m. to 1:30 p.m. or 12:30 p.m. to 4:30 p.m.
Posting Detail Information
Posting Number 2025-060AO Open Date Close Date Open Until Filled Yes Special Instructions to Applicants
Telephonic Nurse Case Mgr II
Utilization review nurse job in Severn, MD
Telephonic Nurse Case Manager II Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
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.
Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST.
* This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria.
The Telephonic Nurse Case Manager II is 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.
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.
* Multi-state licensure is required if this individual is providing services in multiple states.
For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Capabilities, Skills, and Experiences:
* Certification as a Case Manager preferred.
* Ability to talk and type at the same time preferred.
* Demonstrate critical thinking skills when interacting with members preferred.
* Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred.
* Ability to manage, review and respond to emails/instant messages in a timely fashion preferred.
* Minimum 2 years' experience in acute care setting preferred.
* Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred.
* Managed Care experience preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $69,616 - $120,912.00
Locations: Minnesota, Maryland, Columbus, OH
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:
1st Shift (United States of America)
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.
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
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].
Summer Camps Nurse
Utilization review nurse job in Bel Air, MD
Information **Job Title** Summer Camps Nurse **Posting Category** Part-Time Staff **Starting salary range or starting hourly rate range** $3,851 paid over duration of season **Classification Title** Harford Community College (HCC) has been a vital part of Harford County since 1957. As a mid-sized, comprehensive institution, we're committed to delivering high-quality education and cultural enrichment to our community. Our mission is to provide relevant, accessible education and training that connects individuals to opportunities in an ever-evolving world. As an Achieving the Dream institution, HCC is part of a national network dedicated to enhancing student success in community colleges. To learn more about our vision and values, visit our website (************************************************************ .
**Affirmative Action and Equal Employment Opportunity Statement**
Harford Community College is committed to the principles of Affirmative Action and Equal Employment Opportunity. It is the policy of Harford Community College not to discriminate against applicants on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status, or any other characteristic protected by law with regard to any employment practices. HCC is an EEO and ADA/ADAA employer, including disability and protected veteran status.
**Benefits**
**Job Description**
Harford Community College is currently seeking a part-time Summer Camps Nurse for our Summer Youth Camps. Camp season begins June 22, 2026, and continues through August 14, 2026.
The Summer Camps Nurse will serve as the Health Supervisor for HCC Summer Youth Camps, administering and maintaining the summer camp health program. The Health Supervisor is required to be on campus while camps are in session to support, as needed, any medical needs such as asthma, cancer, diabetes, or epilepsy.
**Essential Duties and Responsibilities:**
1. Review and approve the summer camps' health program.
2. Train and collaborate with campus staff to serve as Health Supervisor Designees in their absence, providing simple first aid and overseeing self-administered medication by campers.
3. Maintain health records for campers and staff, and keep a daily log of health or safety incidents as needed.
4. Develop a plan of action for campers identified with behavioral or medical needs.
5. Manage medical supplies and oversee the distribution of first aid supplies to every classroom at the beginning of each camp.
6. Ensure all campers have completed necessary medical forms before attending camp.
7. Follow up with parents regarding incomplete or missing medical forms.
8. Perform other duties as assigned by the supervisor.
The Summer Camps Nurse is required to attend employee training, to be scheduled for the week of June 8th.
Employees of Harford Community College, including instructors for online and virtual courses, must be residents of Maryland or the contiguous states of Delaware, Pennsylvania, Virginia, West Virginia, or the District of Columbia.
**_Applicants must be currently authorized to work in the United States, as the College does not offer Visa sponsorship for this position._**
**Required Education**
Must be a registered nurse licensed and able to currently practice in the state of Maryland.
**Required Experience**
Previous experience in a camp or pediatric setting preferred.
**Required Knowledge, Skills, & Abilities**
+ Ability to successfully pass an FBI, MD, and CJIS background screening.
+ First Aid and CPR/AED certified - HCC offers two free classes to summer camp employees prior to the beginning of camp, dates to be determined.
+ Must be able to work in a camp environment, which may include outdoor activities and varying weather conditions.
+ Strong customer service skills
+ Excellent communication skills.
+ Ability to work and cooperate with co-workers and supervisors at all levels.
+ Ability to work with, within, and promote a diverse workforce and environment.
+ Ability to understand and act on oral and written instructions in English.
+ Ability to learn and perform all essential job functions accurately.
**Preferred Qualifications**
June 22, 2026 to August 14, 2026 availability preferred or at least 4 weeks total availability; conflicts with availability or requested leave time must be submitted at the time of hire for approval.
**General Weekly Work Schedule**
The work schedule is approximately 20 hours per week. Schedules will vary between 8:30 a.m. to 1:30 p.m. or 12:30 p.m. to 4:30 p.m.
Posting Detail Information
**Posting Number** 2025-060AO
**Open Date**
**Close Date**
**Open Until Filled** Yes
**Special Instructions to Applicants**
**Supplemental Questions**
Required fields are indicated with an asterisk (*).
1. *Do you live in Maryland or a contiguous state to Maryland? (PA, DE, VA, WV, DC)
2. Yes
3. No
4. *Will you require sponsorship to work in the United States from Harford Community College?
5. No, I will not require sponsorship from Harford Community College
6. Yes, I will require sponsorship from Harford Community College
7. *Do you have an active RN license in the state of MD?
8. yes
9. no
**Documents Needed To Apply**
**Required Documents**
1. Resume
2. Cover Letter
**Optional Documents**
401 Thomas Run Road
Bel Air, Maryland 21015
************ | **************************
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Copyright © Harford Community College
Easy ApplyTelephonic Nurse Case Mgr II
Utilization review nurse job in Severn, MD
**Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
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.
**Hours:** Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST.
**_***This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria._**
The **Telephonic Nurse Case Manager II** is 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.
**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.
+ Multi-state licensure is required if this individual is providing services in multiple states.
_For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states._
**Preferred Capabilities, Skills, and Experiences:**
+ Certification as a Case Manager preferred.
+ Ability to talk and type at the same time preferred.
+ Demonstrate critical thinking skills when interacting with members preferred.
+ Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred.
+ Ability to manage, review and respond to emails/instant messages in a timely fashion preferred.
+ Minimum 2 years' experience in acute care setting preferred.
+ Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred.
+ Managed Care experience preferred.
For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $69,616 - $120,912.00
Locations: Minnesota, Maryland, Columbus, OH
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 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
Review the 2025-2026 UMMS Benefits Guide
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