Top 34 Utilization review nurse Jobs in Baltimore 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
2d
Registered Nurse Utilization Review
Ascension —Baltimore, MD
- $81,120.00 - $115,939.20 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
Travel RN - Case Management/Utilization Review - Utilization Review
American Traveler —Baltimore, MD
- $1,848.19 a week
- No weekends
- Remote
- RN License
- 5 years
- Writing skills
Quick Apply
10d
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
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
2d
Utilization Management Nurse
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Full-time
- Nursing
- RN License
- Bachelor of Science
- AD&D insurance
- Paid holidays
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
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
3d
Clinical Quality Nurse (RN)
Johns Hopkins Health Plans —Hanover, MD
- $39.64 - $61.45 an hour
- Full-time
- Nursing
- Mid-level
- Bachelor of Science in Nursing
- Health insurance
3d
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
Clinical Documentation Integrity Specialist
Luminis Health —Annapolis, MD
- $93,120 - $136,344 a year
- Full-time
- RN License
- 5 years
- Computer literacy
- AD&D insurance
- Paid holidays
12h
Utilization Management Specialist II
University of Maryland Medical System —Baltimore, MD
- Full-time
- RN License
- Mid-level
- Analysis skills
Utilization Management Nurse - Emergency Department
Luminis Health —Annapolis, MD
- $34 - $55 an hour
- Part-time
- Nursing
- RN License
- Hospital
- AD&D insurance
- Paid holidays
Registered Nurse
Recovery Center of USA, LLC —Baltimore, MD
- $40 - $45 an hour
- Part-time
- Nursing
- Psychiatry
- RN License
Quick Apply
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
PRN Care Manager (RN)
University of Maryland Medical System —Towson, MD
- $38.67 - $50.64 an hour
- PRN
- Nursing
- Hospital
- Inpatient
Care Manager, RN
University of Maryland Medical System —Towson, MD
- Full-time
- RN License
- Hospital
- Inpatient
9d
MDS Coordinator - RN
Oak Crest Village by Erickson Senior Living —Parkville, MD
- $100,000 - $110,000 a year
- 18 years or older
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Home Health Clinical Manager
Centerwell —Towson, MD
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
3d
RN Case Manager
Johns Hopkins Bayview Medical Center —Baltimore, MD
- Full-time
- Nursing
- Surgery
- RN License
- Health insurance
- Opportunities for advancement
4d

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utilization review nurse jobs near baltimore md

Clinical Medical Review Nurse (Remote)

CareFirst BlueCross BlueShield -
Baltimore, MD

Quick Apply

Job Details

Full-time
$67,320 - $133,705 a year
2 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 baltimore md

Clinical Medical Review Nurse (Remote)

Registered Nurse Utilization Review

Travel RN - Case Management/Utilization Review - Utilization Review

Medical Review Nurse III

Care Manager (Remote)

Utilization Management Nurse

Telephonic Case Manager I

Travel RN - Case Management/Utilization Review - Case Management

Clinical Quality Nurse (RN)

RN Bilingual Case Manager - Breast & Cervical Cancer Outpatient Program

Clinical Documentation Integrity Specialist

Utilization Management Specialist II

Utilization Management Nurse - Emergency Department

Registered Nurse

Clinical Referral and Relations Manager, Inpatient

PRN Care Manager (RN)

Care Manager, RN

MDS Coordinator - RN

Home Health Clinical Manager

RN Case Manager

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