Clinical Medical Review Nurse

3 days ago


Owings Mills, Maryland, United States Charter Global Full time
Job Title: Clinical Medical Review Nurse

Location: Hybrid

Duration: Contract

Job Summary:

The Clinical Medical Review Nurse plays a crucial role in handling 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.

Key Responsibilities:
  1. Handle pre and post claim medical review for Commercial, FEP, and Medicare Advantage Plans.
  2. Assist in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies.
  3. Understand the merits of legal or accreditation actions.
Requirements:

3 years acute clinical experience, previous case management, discharge planning, or utilization review experience.

Preferred Qualifications:

Bachelor's degree in Nursing.



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