4 contributing faculty jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Onsite Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working onsite at the assigned hospital up to 5 days per week and occasional weekend work may also be required, both at management's sole discretion. Such work will be conducted with the hospital care team including case managers, social workers and discharge planners...

PerkinElmer Responsibilities Location Annapolis, Maryland US Job ID REQ-057032 This is a full-time salaried position with Project Farma, a PerkinElmer company. The successful candidate will reside in the DC-Maryland-Virginia market and be willing to travel domestically, to meet client project requests. Project Engineers (PE) and Senior Project Engineers (Senior PE) are fully billable roles that will work collaboratively with clients, vendors, contractors, and other Team Members to support projects related to biomanufacturing across the entire engineering lifecycle. PEs and Senior PEs are responsible for delivering high quality work, forming and maintaining valuable, long-term relationships with our clients, and continually strengthening their technical and industry knowledge. They will maintain a strong focus on Project Farma's Patient Focused and People First mindset. Key Responsibilities: Site Strategy Support the execution of site strategy under the...

PerkinElmer Responsibilities Location Annapolis, Maryland US Job ID REQ-057033 This is a full-time salaried position with Project Farma, a PerkinElmer company. The successful candidate will reside in the DC-Maryland-Virginia market and be willing to travel domestically, to meet client project requests. Consultants and Senior Consultants are fully billable roles that will work collaboratively withclients, vendors, contractors, and other Team Members tolead andsupport projects related tobiomanufacturing across the entireprojectlifecycle.Specifically, theyare responsible forleading and mentoringsmall project teamsandidentifyingbusiness development opportunitiesthroughProject Farma'sPatient FocusedandPeopleFirstplatform.Consultants and Senior Consultants are tactical executors focused on project-level delivery, supporting thesiteManager's strategy, and contributing to business growth, talent development, and resource planningwith an emphasis ontechnicalexpertiseand...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: To support the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or recovery of funds. Responsible for providing clinical knowledge to the SI team to support both prepayment reviews and/or post-payment investigations. ESSENTIAL FUNCTIONS: Review of medical records and claims. Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical records. The claims may be in a pre or post payment environment. Provide a detailed but concise analysis to communicate findings about the ability to pay or deny a claim or claim lines using clinical and/or coding, billing, or reimbursement knowledge. Maintain appropriate records and supporting documentation regarding findings in accordance with departmental standards. Process all assigned claims or batch case reviews...