- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse , Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures ... Collaborates with utilization management to develop procedures and reinforce quality standards to support critical-thinking skills and provide and/or...who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. The incumbent will ... Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care complaints in conjunction with Medical Policy....who is willing and able to work in a hybrid model. The incumbent will be expected to work… more
- System One (Baltimore, MD)
- Job Title: Clinical Medical Review Nurse Location: Baltimore, MD 21224 Type: Contract, 5 mos with chance of extension Compensation: Based on experience starting ... at $41.50 / hr Contractor Work Model: Hybrid - Onsite in Baltimore, MD 2-3 days per...to providers for record retrieval, as needed. Clinical Medical Review Nurse / Medical Records Abstraction Specialist… more
- CareFirst (Baltimore, MD)
- …providers who appeal on behalf of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and ... who is willing and able to work in a hybrid model. The incumbent will be expected to work...with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives… more
- CareFirst (Baltimore, MD)
- …in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from ... work experience. **Licenses/Certifications Upon Hire Required:** + RN - Registered Nurse - State Licensure And/or Compact State Licensure. **Experience:** 3 years… more
- Humana (Annapolis, MD)
- …part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record ... rendered is complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently require interpretation… more
- Zurich NA (Annapolis, MD)
- …and work product in area(s) of responsibility. Responsible for overall production, quality and timeliness of supplier. Will handle both complex transactional and ... procedural issue escalations. Conducts regular quality audits and/or reviews to ensure accuracy and completeness...in your career decisions.This position is fully remote. Our hybrid work model is designed to meet our employees'… more
- Humana (Annapolis, MD)
- …to make an impact** **Required Qualifications** + Bachelor's degree + Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) without restriction in ... findings + Proven ability to perform clinical reviews and review medical records + Ability to collaborate and create...is best for your schedule. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided… more
- STG International (Rockville, MD)
- …is currently seeking a Lead Psychologist to provide medical consultation and case review evaluations on Worker's Compensation cases. The candidate must be located in ... the Washington DC Metropolitan area. *Position type: Hybrid schedule Duties and Responsibilities as listed in the contract: The Lead Psychologist provides… more
- Elevance Health (Hanover, MD)
- …onboarding and skill development. + Please note that per our policy on hybrid /virtual work, candidates not within a reasonable commuting distance from the posting ... documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How you will make… more
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