Current jobs related to Clinical Utilization Review Nurse - Baltimore, Maryland - LifeBridge Health

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  Clinical Utilization Review Nurse

  4 weeks ago

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  Baltimore, Maryland, United States Centurion Managed Care Full time

  Job SummaryWe are seeking a skilled Clinical Utilization Review Nurse to join our team at Centurion Managed Care. The successful candidate will be responsible for reviewing requests for prior authorization of medical services, ensuring medical necessity and appropriate level of care.Key ResponsibilitiesPerform on-site and telephonic reviews of patient...

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  Clinical Utilization Review Specialist

  4 weeks ago

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  Baltimore, Maryland, United States LifeBridge Health Full time

  Job SummaryClinical Utilization Review Specialist needed for part-time position at Grace Medical Center. Conduct concurrent and retrospective chart review for clinical, financial and resource utilization information. Provide intervention and coordination to decrease avoidable delays and denial of payment.ResponsibilitiesConduct chart review and abstract...

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  Clinical Medical Review Nurse

  1 month ago

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  Baltimore, Maryland, United States Three Point Solutions Full time

  Job Title: HEDIS Nurse/Clinical Medical Review NurseAt Three Point Solutions, we are seeking a highly skilled Clinical Medical Review Nurse to join our team. As a Clinical Medical Review Nurse, you will play a critical role in ensuring the accuracy and integrity of medical claims and appeals.Key Responsibilities:Receive, research, review, and analyze...

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  Utilization Review and Case Management RN

  4 weeks ago

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  Baltimore, Maryland, United States LifeBridge Health Full time

  Job SummaryLifeBridge Health is seeking a skilled Utilization Review and Case Management RN to join our team. As a Utilization Review and Case Management RN, you will play a critical role in ensuring the efficient use of healthcare resources while providing high-quality patient care.Key Responsibilities:Conduct concurrent and retrospective chart reviews to...

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  Clinical Medical Review Nurse

  4 weeks ago

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  Baltimore, Maryland, United States ICONMA Full time

  We are seeking a skilled Clinical Medical Review Nurse to join our team at ICONMA. This role involves reviewing and analyzing professional and institutional claims using critical thinking and nursing clinical judgment.Responsibilities:35% Reviews and analyzes professional and institutional claims using critical thinking and nursing clinical judgment.25%...

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  Senior Utilization Review Manager

  4 weeks ago

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  Baltimore, Maryland, United States Walker Health Services Full time

  Job DescriptionWalker Health Services is seeking a strategic Utilization Review Manager to lead our Utilization Review department. This individual will oversee the UR process, ensuring compliance with state-specific guidelines, and develop policies and procedures for internal workflows and client interactions.The Manager will focus on optimizing UR...

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  Clinical Medical Review Nurse

  4 weeks ago

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  Baltimore, Maryland, United States ICONMA Full time

  Clinical Medical Review Nurse Job DescriptionWe are seeking a skilled Clinical Medical Review Nurse to join our team at ICONMA. As a key member of our Quality Team, you will play a crucial role in ensuring the accuracy and quality of our HEDIS data.Key Responsibilities:Conduct thorough HEDIS overreads in line with NCQA guidelines, accurately and efficiently...

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  Clinical Medical Review Nurse Specialist

  4 weeks ago

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  Baltimore, Maryland, United States System One Full time

  Job Title: Clinical Medical Review Nurse SpecialistJob Summary:We are seeking a Clinical Medical Review Nurse Specialist to support our HEDIS operations. The successful candidate will conduct thorough medical record reviews, identify and report abstraction errors, and provide measure re-education to abstractors.Key Responsibilities:Accurately and efficiently...

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  Nurse Utilization Manager

  4 weeks ago

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  Baltimore, Maryland, United States Centurion Managed Care Full time

  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...

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  Clinical Medical Review Nurse

  1 month ago

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  Baltimore, Maryland, United States Three Point Solutions Full time

  Job OverviewThree Point Solution is seeking a highly skilled Clinical Medical Review Nurse to join our team. As a key member of our Quality Team, you will be responsible for conducting HEDIS overreads, assisting with medical record retrieval, and participating in internal audits.Key Responsibilities:Conduct HEDIS overreads and correct errors to maintain...

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  Healthcare Utilization Specialist

  4 weeks ago

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  Baltimore, Maryland, United States Collabera Full time

  Job SummaryWe are seeking a skilled Healthcare Utilization Specialist to join our team at Collabera. As a key member of our clinical team, you will be responsible for providing administrative support related to pre-service, utilization review, care coordination, and quality of care.Key ResponsibilitiesPerform member or provider related administrative tasks...

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  Healthcare Utilization Coordinator

  4 weeks ago

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  Baltimore, Maryland, United States Three Point Solutions Full time

  Job Title: Utilization Management Coordinator(Hybrid)Client: Health Care IndustryJob Description:Purpose:Support clinical teams by assisting with administrative tasks related to pre-service, utilization review, care coordination, and quality of care.Key Responsibilities: Perform member or provider related administrative support (e.g., benefit verification,...

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  Senior Clinical Nurse I, Interventional Radiology Specialist

  4 weeks ago

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  Baltimore, Maryland, United States University of Maryland Medical System Full time

  Job SummaryThis role is designed for the nurse who is a clinical and professional leader at the unit level. Demonstrates effective and consistent leadership behaviors in advancing evidence-based practices, leading unit governance initiatives, and coaching others to achieve and grow in the role of the professional nurse.Key ResponsibilitiesProvides...

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  Utility Coordinator

  1 month ago

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  Baltimore, Maryland, United States Whitman, Requardt & Associates, LLP Full time

  Job OverviewWe are seeking a highly skilled Utility Coordinator to join our team at Whitman, Requardt & Associates, LLP. The successful candidate will be responsible for coordinating the identification, protection, and relocation of public and private utilities to accommodate transportation project design and construction.Key ResponsibilitiesResearch and...

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  Clinical Leadership Director

  4 weeks ago

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  Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time

  Job Summary:CareFirst BlueCross BlueShield is seeking a highly skilled Clinical Leadership Director to lead our Utilization Management team. As a key member of our Core Clinical Operations Admin department, you will be responsible for designing, assessing, implementing, and evaluating utilization management strategies to enhance member engagement, improve...

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  Clinical Care Coordinator

  4 weeks ago

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  Baltimore, Maryland, United States Johns Hopkins HealthCare Full time

  About this role:In collaboration with patients, families, social workers, and physicians, the Case Manager provides leadership and advocacy in the coordination of patient-centered care across the continuum. This includes managing clinical resources and transition planning for patients within an assigned caseload from pre-admission through post-discharge.Key...

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  Clinical Leadership Director

  4 weeks ago

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  Baltimore, Maryland, United States CareFirst BlueCross BlueShield Full time

  Job Summary:CareFirst BlueCross BlueShield is seeking a highly skilled Clinical Leadership Director to provide strategic leadership of the utilization management team. The successful candidate will be responsible for designing, assessing, implementing, and evaluating utilization management strategies to enhance member engagement, improve access to quality...

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  Clinical Research Nurse

  4 weeks ago

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  Baltimore, Maryland, United States Cape Fox Shared Services Full time

  Clinical Research NurseCape Fox Shared Services is seeking a highly skilled Clinical Research Nurse to join our team. As a Clinical Research Nurse, you will be responsible for providing high-quality patient care and conducting clinical research studies.Key Responsibilities:Conduct clinical assessments and collect medical histories and physicals.Collect,...

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  Clinical Research Nurse

  1 month ago

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  Baltimore, Maryland, United States Cape Fox Shared Services Full time

  Clinical Research Nurse Job DescriptionCape Fox Shared Services is seeking a highly skilled Clinical Research Nurse to join our team in Baltimore, MD. As a Clinical Research Nurse, you will play a critical role in supporting the National Institutes of Health (NIH) research efforts.Responsibilities:Conduct thorough assessments and collect medical histories...

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  Clinical Nurse Manager Assistant

  4 weeks ago

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  Baltimore, Maryland, United States University of Maryland Medical System Full time

  Job Summary:The University of Maryland Medical System seeks a highly skilled and experienced Assistant Nurse Manager to join our team in the Emergency Department. As a key member of our leadership team, you will be responsible for delivering high-quality patient care services, managing human and fiscal resources, and developing clinical utilization...