Clinical Medical Review Nurse

Clinical Medical Review Nurse

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.

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, nonclient?facing role. The timeframe for this position will fluctuate depending on need.

Key Responsibilities:

• 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.

Additional Skills:

• RN, data analytics, excel, understanding of clinical terminology, cause and effect rationale (inquisitive).

Qualifications:

• 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.

Role Characteristics:

• 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.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.