Job Title: Registered Nurse
Location: Baltimore, Maryland (Hybrid)
Duration: Contract
Job Details:
PURPOSE:
1.The Clinical 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.
2.The incumbent will handle pre and post claim medical review for Commercial, FEP and Medicare Advantage Plans.
3.This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies.
4.This role will also understand the merits of legal or accreditation actions.
Experience: 3 years acute clinical experience, previous case management, discharge planning or utilization review experience
Preferred Qualifications:
Bachelor's degree in Nursing