Nurse - Utilization Review

UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends Baltimore, MD ...

UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends Baltimore, MD ...

UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends Baltimore, MD ...

Overview Clinical Reimbursement Review Nurse is responsible for data collection and data entry that represents the residents' level of care requirements into the utilization software for Maryland Medicaid, in accordance with Federal and State guidelines for residents applying for or continuing a stay in long term care utilizing Medicaid...

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.Job Title: Clinical Medical Review NurseLocation(s): Baltimore, MDThe Clinical Medical Review Nurse handles day to day review of professional and institutional claims and...

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.   Job Title: Clinical Medical Review Nurse Location(s): Baltimore, MD The Clinical Medical Review Nurse handles day to day review of professional and institutional claims...

Our Client, a Health Insurance company, is looking for a Nurse, Clinical Medical Review for their Baltimore, MA /Hybrid location. Responsibilities: 35% Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication,...

Terms of Employment • Contract, 6 Months • This is primarily remote. However, the resources may occasionally be required to visit provider offices for record retrieval and come onsite to Baltimore, MD and/or Owings Mills, MD for (infrequent) meetings. There is one week of onsite training. Overview Our client is seeking HEDIS Medical Review Nurses to...

PURPOSE: The Clinical Medical Review Nurse (an RN with clinical experience) will report to the Clinical Support Supervisor – HEDIS and be part of the Quality Team. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment,...

Job Description: PURPOSE: The Clinical Medical Review Nurse (an RN with clinical experience) will report to the Clinical Support Supervisor - HEDIS and be part of the Quality Team. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk...

Job DetailsDescriptionWe are seeking a skilled Nurse Utilization Manager to join our Maryland Regional Office Team. The successful candidate will be responsible for reviewing requests for prior authorization of medical services, ensuring medical necessity and appropriate level of care. This includes admissions through on-site and telephonic review, as well...

The Medical Review Nurse (MRN) will support the Federal Team by reviewing medical claims to ensure services are reasonable, necessary, and compliant with national/local policies and coding practices. The role involves assessing Medicare Beneficiary r Medical, Nurse, Healthcare, Staffing

The Medical Review Nurse (MRN) will support the Federal Team by reviewing medical claims to ensure services are reasonable, necessary, and compliant with national/local policies and coding practices. The role involves assessing Medicare Beneficiary records, evaluating medical coding, and making determinations based on established guidelines. The MRN may also...

ALTA IT Services is staffing a contract to hire opportunity for a Utilization Management Nurse to support a leading health insurance customer. The UM Nurse will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills,...

Our Client, a Health Insurance Company, is looking for Utilization Management Specialist for their Baltimore, MD/Hybrid location Responsibilities: Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and...

Description Home Search Jobs Job Description Utilization Manager Contract: Baltimore, Maryland, US Salary: $22.00 Per Hour Job Code: 355298 End Date: 2024-11-24 Days Left: 28 days, 3 hours left Apply About the Role: We are seeking a Utilization Management Support Specialist to assist our clinical teams with non-clinical administrative tasks related...

Description Home Search Jobs Job Description Utilization Manager Contract: Baltimore, Maryland, US Salary: $22.00 Per Hour Job Code: 355298 End Date: 2024-11-24 Days Left: 2 hours left Apply About the Role: We are seeking a Utilization Management Support Specialist to assist our clinical teams with non-clinical administrative tasks related to...

ALTA IT Services is staffing a contract opportunity for a Clinical HEDIS Specialist support a leading health insurance customer. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for...

Position: Utilities Service ManagerDuration: Permanent Location: Baltimore, MDSalary: 90k-150k Must Haves:Bachelor's Degree in an Engineering field or the technical equivalent.Ten years’ experience in plant management or other related experience.Current State of Maryland 1st Grade Stationary Engineer’s license.Prior supervisory experience.Extensive...

Position: Clinical Medical Review Nurse Duration: 6 Months ContractClient: Medical Device Manufacturing Company Location: Baltimore MD 21224Job Description: The Clinical Medical Review Nurse (RN/LPN) will report to the Clinical Support Supervisor - HEDIS and work as part of the Quality Team. Responsibilities include conducting HEDIS overreads per NCQA...