Medical Review - Baltimore, MD

We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. · ...

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 ...

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 proc ...

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 ...

A Clinical Medical Review Nurse will be reviewing medical records and extracting clinical data. · ...

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 · ...

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 ...

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

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 ...

Clinical medical review nurse to collect medical records and extract clinical data from provider offices in MD. · ...

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 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. · Ability to effectively ...

+This role combines clinical medical review and medical record abstraction responsibilities. · +Claims Review & Analysis (35%): Review and analyze professional and institutional claims using critical thinking, nursing judgment, and corporate/medical policies. · ...

+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 proce ...

This position involves reviewing Medicare Fee-for-Service claims to assess overpayments underpayments and proper payments as determined by Recovery Audit Contractors RACs.RVC Reviewers perform automated and complex reviews of claims including Part A B DMEPOS and Home Health Hospi ...

The Clinical Medical Review Nurse handles day to day review of professional and institutional claims. · The incumbent will handle pre and post claim medical review for Commercial, FEP and Medicare Advantage Plans. · ...

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 ...

We are seeking a Remote Medical General Expert - AI Trainer based in Baltimore, MD. · Develop and refine AI healthcare models. · ...