Medical Review Nurse


Seeking a Medical Review Nurse for a long term contract position with our customer, a major Healthcare Insurance organization in the Maryland area. The 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, FEP and Medicare Advantage Plans. This position assists in determining acceptable medical risk to the organization by analyzing medical information of applicants for enrollment in specific policies. Specifically, we are seeking candidates that are RN or LPN certified, and have specific knowledge with HEDIS medical chart review experience.

This position is a hybrid opportunity, reporting to our clients office in Owings Mills or Canton MD once per week (sometimes less, sometimes more).

Required Skills


- RN or LPN certified is a requirement.
- Experience: 3 years acute clinical experience, previous case management, discharge planning or utilization review experience
- Bachelor's or Associate-s degree in Nursing is highly preferred
- Must have HEDIS medical chart review experience. CareSeed knowledge considered a BIG PLUS
- Ability to effectively communicate and provide positive customer service to every internal and external customer
- Current knowledge of clinical practices and related medical policies.
- EPIC software = big plus

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Location

Hybrid, Owings Mills or Canton, MD

Openings

1

Anticipated Start Date

Monday, November 11, 2024

Job Type

Contract

Anticipated Duration

12 month+

Date Posted

Friday, October 18, 2024

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Elite Technical Services, Inc. participates in the E-Verify program to confirm the employment eligibility of all persons hired. This means that we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. Elite Technical Services, Inc. will not use E-Verify to pre-screen job applicants.

Elite Technical Services, Inc. is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.