Utilization Review RN (Hybrid) - Medical Necessity Expert
State of Maryland
State of Maryland, MDH, Maryland Healthcare System in Catonsville, MD, seeks a nurse reviewer to conduct admissions, continuation of care reviews, and readmissions, while managing the denial process. This role addresses the MDH waitlist by identifying patients who no longer meet medical necessity criteria. Reviews are independent of treatment teams with objective feedback to hospitals. The position is hybrid with teleworking options and contributes to reporting that identifies care-improvement #J-18808-Ljbffr State of Maryland
- Telligen is seeking a Senior Review Coordinator to conduct utilization reviews and medical management for various services. The role involves mentoring teammates, conducting... ...standards. Ideal candidates must hold an active RN license in Maryland, possess a relevant four-year...MedicalCasual work
- ...Physician Advisor to join our system in a hybrid role supporting hospitals across... ...System. The physician advisor uses medical expertise to optimize resource use,... ...care. Responsibilities include reviewing patient status and utilization, leading denial interventions, engaging...Medical
$34 - $55 per hour
...Utilization Management Nurse Full Time - Day shift (Monday-Friday, 8a-5p), hybrid (Work from both office & home. Must be... ...retrospective chart review for clinical, financial... ...: Reviews the medical record by applying utilization... ...: ~ Current RN license from...MedicalFull timeWork at officeWork from homeMonday to FridayDay shift- As a Senior Review Coordinator, you will be responsible for conducting utilization review/medical management including prospective, concurrent and retrospective review for all... ...timely Required Skills and Experience Active RN license that is recognized in the state of Maryland...MedicalContract workCasual workWork at office
$32.18 - $49.46 per hour
Boston Medical Center is seeking a dedicated Mother/Baby Registered Nurse 2 for a full-time role. The nurse will provide direct patient... ...should possess an Associate Degree in Nursing and a valid Maryland RN license. The position offers a competitive salary ranging from $...MedicalFull timeNight shift- J29, Inc. seeks experienced RVC Reviewers to perform automated and complex reviews of Medicare FFS claims, ensuring proper payments and... ...collaboration across teams. Qualified candidates have 5+ years in medical coding, experience with DRG validation, and remote work...MedicalRemote job
- ...several CDI Specialists to support documentation and clinical review for a top healthcare client. This 6+ month contract offers remote... ...orientation in Maryland (travel reimbursed). You will analyze medical charts, summarize findings for physicians, and contribute to improving...MedicalContract workWork at officeRemote work
$81.97k - $122.95k
...Luminis Health Title: Utilization Review/Case Manager-Partial Hospitalization Program Department... ...Utilization Review Plans. Works with medical and professional staff to obtain... ...referral. # Determines the medical necessity and appropriateness of admission, using...MedicalFull timePart time- Johns Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply clinical, managed care and utilization review expertise to... ...authorizations or denials, and initiate discharge planning. Maryland RN license (or compact) and 3+ years acute care experience plus 1...Remote job
- ...Responsibilities The Applications Development Expert provides design recommendations based on... ...business critical software solutions, utilizing appropriate software engineering... ...and planning support Health Insurance (Medical, Dental, Vision) Health Savings Account...MedicalTemporary workWork experience placementFlexible hours
$2,366 per week
...Registered Nurse (RN) | Case Manager Location... ...case management for all medical and surgical patients.... ...assessments and continued stay reviews. Coordinate discharge... ...and HIPAA guidelines. Utilize charting systems... ...management. Manage medical necessity determinations based on...MedicalFull timeContract workMonday to FridayShift work$79.22k - $118.83k
...assessments (OASIS) including medication reconciliation accurately and... ...eligibility and medical necessity guidelines, determines primary... ...participates in the agency's utilization management model You... ...~ Current and unrestricted RN licensure in state of practice...MedicalHourly payMinimum wageFull timeWork experience placementLocal areaRelocation packageFlexible hoursWeekend workWeekday work- YO AI Labs is seeking a Pharmacovigilance Expert to contribute drug safety expertise to a healthcare AI project. You will review and refine pharmacovigilance documentation, safety reports, and regulatory content, applying ICH and GVP standards. AI-backed safety reviews...Remote job
$31 - $44.64 per hour
...DialysisApplylocations: Garrett Regional Medical Center (GRMC)time type: Part... ...scope of a Registered Nurse (RN) - Level I & II, as defined... ..., implementation, and review of and adherence to policies that... ...positioning will be completed utilizing the lift equipment and/or other...MedicalLocal areaFlexible hoursShift work$34 - $54 per hour
...patient care plans, participating in quality improvement initiatives, and maintaining certifications such as Chemotherapy/Immunotherapy. The pay ranges from $34 to $54, with various benefits including medical, dental, and tuition assistance. #J-18808-Ljbffr Luminis HealthMedical$110k - $135k
...quality in every aspect. As healthcare IT experts, Apex is committed to building systems... ...Program by linking operational, materiel, and medical data to survivability and acquisition... ...high‑quality technical reports, peer‑reviewed publications, and detailed Casualty Operating...MedicalContract workWork at office$205k - $225k
Title: Expert System Administrator Location: Annapolis Junction, MD Compensation Range:... ...Cornerstone Defense. Benefits Overview Medical, Dental and Vision Plans Generous PTO Policy... ...Optimize system operations and resource utilization and perform system capacity analysis and...Medical- Crisis24 is hiring a Medical Assistance Nurse Advisor in Annapolis, Maryland. This role supports insurers and brokers worldwide, reviewing medical information and providing expert opinions for patient care. You will work within a collaborative Medical Operations team,...MedicalWorldwide
- ...requires strong actuarial/financial modeling skills and expertise with MoSes/AXIS/ALFA, plus programming in Python/C++. The position is hybrid, located in Baltimore, Cedar Rapids, or Philadelphia, with three days in office per week. Collaboration with ALM, risk, and finance...Work at office3 days per week
$39.8 - $66.26 per hour
...and in consultation with the responsible medical oncologist and/or advanced practitioner,... ...with the multi-disciplinary team and utilizes clinical outcomes data to support innovative... ...skills and interview techniques b) Reviewing pertinent laboratory results c) Reviewing...MedicalReliefWork at officeLocal areaShift work- ...takes all high acuity patients from medical, surgical, and cardiac. We provide... ...free and onsite. Scope of work The RN, under the ANA scope of practice utilizes the framework of the nursing... ...vaccine requirement if in an on-site or hybrid workplace category. We are committed...MedicalFull timeShift workNight shiftWeekend work
- ...FULL-TIME and PART-TIME Hybrid positions where... ...program for addressing HRSN utilizing an evidence-based, structured... ..., Registered Nurse (RN) will travel to members... ...the health plan’s review and audit. Complete required... ...lactation, and related medical conditions), national...MedicalFull timeContract workPart timeWork at officeWork from homeRelocation packageFlexible hoursShift workWeekend workAfternoon shift
- YO AI Labs is seeking a Medical Writer Expert for a remote contract to develop, review, and evaluate clinical and regulatory documents with scientific precision and regulatory compliance. You will author CSRs, interpret protocols, verify data integrity, and support AI-...MedicalRemote jobContract work
- ...Case Manager RN Provide case management for all medical and surgical patients. Manage patient... ...and continued stay reviews. Coordinate discharge planning... ...and HIPAA guidelines. Utilize charting systems... ...management. Manage medical necessity determinations based on...MedicalTemporary workLocumLocal areaMonday to Friday
- ...Case Manager RN Signon Bonus $5,000 for External Applicants... ...members who often have multiple medical, behavioral, and social... ...clinical tools and information/data review to conduct an evaluation of members... ...goals and objectives. Utilize case management processes in compliance...MedicalFull timeTemporary workLocal areaRemote workRelocation packageMonday to Friday1 day per week
- ...and Halethorpe communities. Responsibilities include providing primary and urgent care, performing initial evaluations with physical exams, setting up and monitoring medical equipment, communicating test results, recording medical #J-18808-Ljbffr Priority Care ClinicsMedical
- ...a results-driven pharmaceutical sales professional to achieve territory sales goals by promoting products to physicians and other medical personnel within the assigned geography. You will educate customers on indications and product use, and ensure high visibility and...Medical
- ...our team by applying today! Responsibilities The Subject Matter Expert defines the problems and analyzes and develops plans and... ...maximum Financial education and planning support Health Insurance (Medical, Dental, Vision) Health Savings Account (HSA) Medical and Dependent...MedicalTemporary workFlexible hours
$10k
...without regard to race, religion, creed, color, national origin, ancestry, sex (including pregnancy, childbirth, breastfeeding, or medical conditions related to pregnancy, childbirth, or breastfeeding), age, medical condition, marital or domestic partner status, sexual...MedicalContract workTemporary workImmediate start- ...information and authorization between the hospital and third-party payors, supporting the utilization review process. The role involves reviewing Case Manager worklists, communicating medical record information to payors for authorizations, and ensuring timely responses and...Medical
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review RN (Hybrid) - Medical Necessity Expert. Be the first to apply!
- wound rn Annapolis, MD
- non clinical rn Annapolis, MD
- clinic registered nurse rn Annapolis, MD
- outpatient surgery centers rn Annapolis, MD
- part time rn Annapolis, MD
- rn relocation bonus Annapolis, MD
- registered nurse healthcare Annapolis, MD
- rn relocation assistance Annapolis, MD
- wound care rn registered nurse Annapolis, MD
- school rn Annapolis, MD


