RN Clinical Medical Review Nurse

Working remotely from the greater Baltimore metropolitan area, the full-time RN Clinical Medical Review Nurse will manage the review of professional and institutional claims, analyze medical information for enrollment eligibility, and support claims processing and adjudication. Key responsibilities Receives, researches, reviews, and analyzes claims using nursing clinical judgment and corporate policies Provides pricing of procedure codes and interprets medical information utilizing CPT and HCPCS manuals Participates in medical policy meetings and collaborates with medical directors on special projects Required qualifications Bachelor's degree in Nursing or equivalent work experience (4 years in lieu of a degree) Current RN state licensure or compact state licensure in VA, DC, or MD Minimum of 3 years of acute clinical experience, including case management or utilization review Experience in making clinical decisions related to pre-claim submissions and appeals Proficiency in Microsoft Office and web-based technology