Clinical Medical Review Nurse
Ampcus
Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse.
Location: Owings Mills, MD. Summary:
Location: Owings Mills, MD. Summary:
- The Contingent RN supports CareFirst by analyzing high-cost claimant and population health data to support utilization review, ad-hoc requests, and client reports.
- This position requires experience excising and understanding medical terminology, analytical expertise, and cross-team collaboration in a fast-paced, data-driven environment. This is an internal, non-client-facing role. The timeframe for this position will fluctuate depending on need.
- Retrieve and interpret clinical, financial, and population health data across multiple systems.
- Identify trends, gaps in care, and opportunities for improved health outcomes.
- Provide clinical expertise and translate complex data into clear insights for internal stakeholders.
- Support cost-containment and quality-improvement initiatives through data-driven recommendations.
- Communicate effectively across teams and levels, including leadership.
- Work independently with minimal supervision while maintaining accuracy and meeting deadlines.
- RN, data analytics, excel, understanding of clinical terminology, cause and effect rationale (inquisitive).
- Registered Nurse (RN) - active state or compact license.
- 4 years' clinical experience plus 2 years of healthcare data analysis.
- Proficiency in Excel, Word, PowerPoint; strong analytical and critical-thinking skills.
- Ability to influence and collaborate with stakeholders across the organization.
- Bachelor's degree required (or 4 years' equivalent experience).
- Preferred: Graduate degree (MSN, MBA, MPH) and experience within a health plan or business-focused role.
- Individual contributor who researches high-cost claimants, populates slide decks, and responds to ad-hoc requests.
- Resolves moderately complex problems using established processes and clinical judgment.
- Frequent cross-department communication.
- Represents the team with professionalism and a collaborative mindset.
- Remote work environment with minimal physical demands.
Vacancy posted 5 days ago
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