Elite Technical

Compensation

Full Description

Medical Review Nurse job at Elite Technical . Canton, MI. 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 Apply Now