Utilization Review Nurse - Hanover, MD

The Nurse Educator/Review Coordinator's primary role is to facilitate provider education related to the claim reviews performed under Task Order 3 for the BFCC-QIO contract. · ...

Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines.Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most eff ...

The Nurse Educator/Review Coordinator's primary role is to facilitate provider education related to the claim reviews performed under Task Order 3 for the BFCC-QIO contract. · Graduation from an accredited school of nursing and current licensure as Registered Nurse (RN) or accred ...

The role of the Nurse Quality Review Utilization Management UM is to evaluate clinical quality and procedures within the Utilization Management UM program to maximize efficiency ensure compliance and optimize patient care and safety.This position supports utilization management a ...

Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. · ...

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. · They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of ...

The role of the Nurse, Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within the Utilization Management (UM) program to maximize efficiency, ensure compliance and optimize patient care and safety. · This position supports utilization man ...

Make it happen at Hopkins As a member of Johns Hopkins Medicine, Johns Hopkins Howard County Medical Center is a 266-bed acute care facility that has been serving the community for nearly 40 years. We can offer the most advanced, innovative technology with the collaboration and t ...

We are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as Clinical Medical Review Nurses. · Review and abstract data from medical records · Extract relevant clinical data using Electronic Medical Record (EMR) systems · ...

Seeking a Medical Review Nurse for long term contract position with major Healthcare Insurance organization in Maryland area. · ...

This role combines clinical medical review and medical record abstraction responsibilities.The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims process ...

This role combines clinical medical review and medical record abstraction responsibilities. The position handles day-to-day review of professional and institutional claims, provider appeals, · and medical record abstraction to determine benefit eligibility and support claims proc ...

This position requires residence in Maryland and the ability to work on-site at our client's Baltimore office 2-3 days per week. Join a dedicated Government Programs quality team at a leading healthcare organization. · Perform detailed abstractions of clinical data from member me ...

This role combines clinical medical review and medical record abstraction responsibilities. The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims proces ...

The Clinical Medical Review Specialist will report to the Clinical Support Supervisor and be part of the Quality Team. · Chart retrieval · Conduct thorough medical record reviews in line with NCQA specifications using proprietary tools and software. · Retrieval follow-up, escalat ...

We are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as Clinical Medical Review Nurses. ...

We are seeking a Medical Review Nurse for long term contract position with our customer in the Maryland area.This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. · ...

We are seeking two skilled and detail-oriented Clinical Review Nurses for a 5-month contract. · Perform detailed abstractions of clinical data from member medical records. · Review and extract key information from provider records to support HEDIS quality measures. · ...

This role combines clinical medical review and medical record abstraction responsibilities. The position handles day-to-day review of professional and institutional claims, provider appeals, and medical record abstraction to determine benefit eligibility and support claims proces ...

Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care. · Competitive compensation (additional compensation such as overtime, shift differentials, premium pay, and bonuses may apply depending on ...