Top 21 Remote nurse Jobs in Towson, Md

Clinical Medical Review Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,320 - $133,705 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
5d
Clinical Appeals Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,320 - $133,705 a year
- Full-time
- Remote
- Nursing
- Addiction Medicine
- RN License
- 401(k)
Quick Apply
11d
Telephonic Case Manager I
CorVel Corporation —Nottingham, MD
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
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RN Telehealth Administrator on Call, Remote, PRN
Personalized Health Partners —Linthicum Heights, MD
- 8 hour shift
- Remote
- RN License
- Mid-level
- Outpatient experience
Quick Apply
Clinical Support Specialist
Vheda Health —Columbia, MD
- $0 a year
- Full-time
- Remote
- Spanish
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Travel RN - Case Management/Utilization Review - Utilization Review
American Traveler —Baltimore, MD
- $2,004.08 a week
- Weekends as needed
- Remote
- RN License
- 5 years
- Writing skills
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Clinical Support Specialist
Vheda Health, Inc. —Columbia, MD
- $40,000 - $70,000 a year
- Full-time
- Remote
- Spanish
- RN License
- Mid-level
- Paid holidays
- Health insurance
Remote - Care Coordinator - LPN - LVN - $21/hr - Day Shift
CareHarmony —Baltimore, MD
- $43,000 - $58,000 a year
- Full-time
- Remote
- Bilingual
- Mid-level
- 3 years
- Paid holidays
- Health insurance
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Clinical Adherence Nurse (RN), Bilingual - Per Diem
Scene Health —Baltimore, MD
- $35 an hour
- Weekends as needed
- Remote
- Spanish
- RN License
- 5 years
Bilingual Clinical Support Specialist
Vheda Health —Columbia, MD
- $40,000 - $60,000 a year
- Full-time
- Remote
- Spanish
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Bilingual Clinical Support Specialist
Vheda Health, Inc. —Columbia, MD
- $40,000 - $70,000 a year
- Full-time
- Remote
- Spanish
- RN License
- Mid-level
- Paid holidays
- Health insurance

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Registered Nurse (RN) Case Manager / Utilization Review | Licensed Clinical Social Worker (LCSW)
Business Integra INC —Glen Burnie, MD
We are seeking an experienced *RN Case Manager *for a 13-week acute *inpatient care coordination position* requiring an active MD or Compact RN license and at…
$2,000 - $2,320 a week
Quick Apply
11h
RN Team Lead Utilization Review
MedStar Health —Clinton, MD
Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high-quality cost-effective manner by…
$89,065 - $162,801 a year
4d

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Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Columbus, OH
A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across…
$54,095 - $155,538 a year
Clinical Quality Assurance Specialist, RN
Wider Circle —Columbus, OH
An active, unrestricted RN, NP, LPN, or LCSW license (a multi-state or compact license is preferred). You can pull, sort, and understand QA data on your own.
$80,000 - $95,000 a year
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10h

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remote nurse jobs near towson, md

Clinical Medical Review Nurse (Remote)

CareFirst BlueCross BlueShield -
Baltimore, MD

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Job Details

Full-time
$67,320 - $133,705 a year
5 days ago

Benefits

401(k)

Qualifications

Customer communication
Nursing
RN License
Research
Handling customer service requests
Acute care experience
Nursing

Full Job Description

Resp & Qualifications

PURPOSE:
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. The incumbent will handle post claim medical review for Commercial lines of business. This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. This role will also understand the merits of legal or accreditation actions. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. The ideal candidate will have previous experience making clinical decisions related to post claim submission and/or appeals and grievances within a health payer organization.

ESSENTIAL FUNCTIONS:

Receives, research, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication. Performs high-level research on topics identified as actual or potential medical policies. Assesses and communicates impact of information on medical policy.
Provides pricing of procedure codes which require individual consideration or are listed as "not otherwise classified" in CPT manual. Interprets the descriptive or medical information utilizing the CPT and HCPCS manuals.
Participates in medical policy meetings, nurses' forums, and review sessions with Medical and Dental directors, special projects and task forces committees as assigned.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications Upon Hire Required:

RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD.

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

Preferred Qualifications:

Bachelor's degree in Nursing.
Previous experience making clinical decisions related to post claim submission and/or appeals and grievances within a health payer organization.

Knowledge, Skills and Abilities (KSAs)

Ability to effectively communicate and provide positive customer service to every internal and external customer.
Strong interpersonal skills. Ability to work independently, as well as a member of a team.
Current knowledge of clinical practices and related medical policies.
Strong organizational skills, ability to prioritize responsibilities with attention to detail.
Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology.
Must possess excellent verbal and written communication skills.

Salary Range: $67,320 - $133,705

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-SS1

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Refine Your Search

remote nurse jobs in towson, md

Clinical Medical Review Nurse (Remote)

Clinical Appeals Nurse (Remote)

Telephonic Case Manager I

RN Telehealth Administrator on Call, Remote, PRN

Clinical Support Specialist

Travel RN - Case Management/Utilization Review - Utilization Review

Clinical Support Specialist

Remote - Care Coordinator - LPN - LVN - $21/hr - Day Shift

Clinical Adherence Nurse (RN), Bilingual - Per Diem

Bilingual Clinical Support Specialist

Bilingual Clinical Support Specialist

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