Medical Records Review Nurse - Baltimore, MD

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 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. · ...

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

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 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 ...

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 ...

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 proces ...

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 proc ...

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 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 ...

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. · ...

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 ...

Join a team that values innovation and outcomes, delivering life-saving care to our youngest and most vulnerable patients. · Medical necessity review of patient stays and referral to the physician advisor as needed · ...

+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 ...