Top 28 Utilization review nurse Jobs in Annapolis, 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
9d
Care Manager (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $72,360 - $143,715 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
9d
Utilization Reviewer
University of Maryland Medical System —Largo, MD
- $40.61 - $60.96 an hour
- Full-time
- Nursing
- RN License
- Hospital
7d
Utilization Management Nurse
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
- AD&D insurance
- Paid holidays
Utilization Management Specialist II
University of Maryland Medical System —Baltimore, MD
- Full-time
- RN License
- Mid-level
- Analysis skills
Clinical Care Coordinator
University of Maryland Medical System —Largo, MD
- $47.00 - $70.54 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Paid time off
Case Manager
Mercy Medical Center —Baltimore, MD
- $36.92 - $66.46 an hour
- Full-time
- Nursing
- RN License
- Hospital
- 403(b) matching
- Paid holidays
1d
Medical Review Nurse III
RELI GROUP INC —Baltimore, MD
- $80,000 - $95,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
MEDICAL SERVICES REVIEWING NURSE II
State of Maryland - MDH Executive Direction —Baltimore, MD
- $87,253 - $112,878 a year
- Online Application
- Nursing
- RN License
- Mid-level
4d
Utilization Management Nurse - Emergency Department
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Part-time
- Nursing
- RN License
- Hospital
- AD&D insurance
- Paid holidays
Clinical Referral and Relations Manager, Inpatient
Kennedy Krieger Institute —Baltimore, MD
- $71,518.51 - $127,585.95 a year
- Full-time
- Hybrid work
- CPR Certification
- Nursing
- RN License
- Free parking
- Loan repayment program
RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program
MedStar Health —Baltimore, MD
- $86,000 a year
- Full-time
- Background check
- Spanish
- Nursing
Quick Apply
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Baltimore, MD
- $1,963.06 a week
- 8 hour shift
- CPR Certification
- RN License
- BLS Certification
Quick Apply
10d
RN Case Manager
Johns Hopkins Bayview Medical Center —Baltimore, MD
- Full-time
- Nursing
- Surgery
- RN License
- Health insurance
- Opportunities for advancement
11d
JHH RN Case Manager (Intrastaff)
Johns Hopkins Medical Management Corporation —Baltimore, MD
- $55 an hour
- Temporary
- Nursing
- RN License
- Hospital
Quick Apply
Assistant Nurse Manger - Full Time - Day shift 6am-2pm, rotating weekends, rotating holidays
Gaudenzia —Crownsville, MD
- $100,000 - $105,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Senior Case Manager II
University of Maryland Medical System —Baltimore, MD
- Full-time
- Acute care
- Nursing
- RN License
Medical Field Case Manager
Enlyte —Baltimore, MD
- $79,000 - $95,000 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Travel reimbursement
- Health savings account
4h
Registered Nurse
Recovery Center of USA, LLC —Baltimore, MD
- $40 - $45 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
Quick Apply

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Care Manager (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member's…
$72,360 - $143,715 a year
Quick Apply
9d
Project Manager - Organizational Readiness, Communications and Training (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
Ability to use graphic design tools such as Canva. Education Level: Bachelor's Degree in Project Management, Business or related field OR in lieu of a…
$69,624 - $138,281 a year
Quick Apply
8d

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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
9d

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utilization review nurse jobs near annapolis, 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
9 days ago

Benefits

401(k)

Qualifications

Customer communication
Nursing
RN License
Research
High school diploma or GED
Individual consumer customer service
Risk assessment
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 pre and post claim medical review for Commercial and Govt Programs. 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. This role sits within the Forensic Nurse Team in Payment Integrity.

ESSENTIAL FUNCTIONS:

Receives, researches, 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. Keeps up to date on coding rules and standards.
Participates in medical policy meetings, nurses' forums, and review sessions with Medical and Dental directors, special projects and task forces committees as assigned.
Performs medical underwriting and risk assessment by reviewing applications of potential subscribers, as well as any appropriate medical records.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

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.
Certified Coding Professional (Inpatient).

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-LY1

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Refine Your Search

utilization review nurse jobs in annapolis, md

Clinical Medical Review Nurse (Remote)

Care Manager (Remote)

Utilization Reviewer

Utilization Management Nurse

Utilization Management Specialist II

Clinical Care Coordinator

Case Manager

Medical Review Nurse III

MEDICAL SERVICES REVIEWING NURSE II

Utilization Management Nurse - Emergency Department

Clinical Referral and Relations Manager, Inpatient

RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program

Travel RN - Case Management/Utilization Review - Case Management

RN Case Manager

JHH RN Case Manager (Intrastaff)

Assistant Nurse Manger - Full Time - Day shift 6am-2pm, rotating weekends, rotating holidays

Senior Case Manager II

Medical Field Case Manager

Registered Nurse

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