Clinical Medical Review Nurse Job at Elite Technical , Maryland

c2hUZS9MTjRmaE9KSnZnRnR3MWpSZVJZaHc9PQ==
  • Elite Technical
  • Maryland

Job Description

Clinical Medical Review Nurse

Seeking a Medical Review Nurse for a long term contract position with our customer, a major Healthcare Insurance organization in the Maryland area. The Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent will handle pre and post claim medical review for Commercial, FEP and Medicare Advantage Plans. This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. Specifically, we are seeking candidates that are RN or LPN certified, and medical chart review experience.

This position is a hybrid opportunity, reporting to our clients office in Canton MD 2-3x per week.

Required Skills


- RN or LPN certified is a requirement. Licensed in Maryland. (Licensure Compact-(NLC) acceptable)
- Experience: 5+ years acute clinical experience, previous case management, discharge planning or utilization review experience.
- Must have strong Medical Abstraction/Data Analysis abilities
- Bachelor's or Associate-s degree in Nursing is highly preferred
- Big Plus: HEDIS medical chart review experience. Overreading also a big plus
- CareSeed knowledge considered a BIG PLUS
- Expertise within any EMR is required (Big Plus would be Epic, eClinical or Cerner)
- Ability to effectively communicate and provide positive customer service to every internal and external customer
- Current knowledge of clinical practices and related medical policies.

Apply Now

Job Tags

Contract work, Long term contract, Work at office,

Similar Jobs

Gundersen Health System

Registered Nurse, RN | Long Term Care | $2,500 Sign-On Bonus Job at Gundersen Health System

 ...Sign-On Bonus Gundersen Tweeten Care Center, a long-term skilled nursing care facility located in Spring Grove, MN, is dedicated to...  ...Minnesota Minimum of an Associate Degree in Nursing CPR Certified No experience required! Emplify Health is comprised of two of the Midwest's... 

Lensa

Research Assistant Job at Lensa

 ...Job Description Participates collaboratively in various research projects and performs investigative research in a particular area...  ...the guidance of an investigator, associate investigator or assistant investigator. ~ Follows and adheres to experimental... 

Insight Global

Salesforce Cloud Technical Lead Job at Insight Global

 ...request to ****@*****.*** learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: Skills and Requirements Must-Haves: Certified Salesforce Consultant Lifescience... 

Design Observer

Junior Industrial Designer Job at Design Observer

 ...About The Role As a Jr. Industrial Designer, you will play a crucial role in supporting the design and development of innovative products that meet both functional and aesthetic requirements. You will collaborate closely with senior designers, engineers, and production... 

Archdiocese of St. Louis

Para-Professional - St. Ambrose Job at Archdiocese of St. Louis

 ...The Archdiocese of St. Louis Catholic Education and Formation features an expansive coalition of schools that allow our children to develop a sense of purpose and value, receive a higher quality education, join a welcoming community and feel secure in a a dynamic future...