- Evolent (Annapolis, MD)
- …scheduled. + Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks… more
- Elevance Health (Hanover, MD)
- ** Nurse Reviewer I** A proud member...reviews that are routine having limited or no previous medical review experience requiring guidance by more ... Hours:** **Monday through Friday, 9:30AM - 6PM (CST).** The ** Nurse Reviewer I** is responsible for conducting...+ Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization request… more
- CareFirst (Baltimore, MD)
- …State and Federal regulations and mandates. + Organizes the appeal case for physician review by compiling clinical , contractual, medical policy and claims ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic...psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review , Utilization Management or Case Management… more
- Fresenius Medical Center (Towson, MD)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- Actalent (Westminster, MD)
- Job Title: Clinical Research Coordinator Job Description Join our team as a Clinical Research Nurse for an ongoing clinical trial, where you will play a ... crucial role in facilitating clinical research activities within a dynamic healthcare setting. This...care and support to patients throughout the study. + Review patient charts and electronic medical records… more
- Fresenius Medical Center (Baltimore, MD)
- …regulations at: https://content.intranet.fmcna.com/regulatory-affairs/wp-content/uploads/sites/46/2019/05/Pre-Licensed- Nurse -50-State- Review ... of the hemodialysis health care team as a Registered Nurse Applicant, under the direction or supervision of a...transcribes, and enters physician lab orders accurately into the Medical Information System. + Ensures appropriate preparation of lab… more
- Gentiva (Beltsville, MD)
- …(LCD) criteria per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and ... Partnerships. Transform Hospice Care.** We are seeking a dedicated Hospice Nurse Practitioner to perform Face-to-Face (F2F) encounters essential for hospice… more
- Johns Hopkins University (Baltimore, MD)
- …of assigned clinical trials within the research program. The Research Nurse is responsible for the oversight of the administrative and scientific implementation ... at the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. The Research Nurse is responsible...review of institutional SOPs about the performance of clinical research. _Leadership_ + Facilitate teamwork between the research… more
- Johns Hopkins University (Baltimore, MD)
- The Department of Emergency Medicine is seeking a **_Sr. Nurse Practitioner_** to work collaboratively within a multidisciplinary health care team. Responsible for ... and physical including chief compliant, presenting signs and symptoms, and past medical history and interval history. + Recognize differences between normal and… more
- Johns Hopkins University (Baltimore, MD)
- …and physical including chief compliant, presenting signs and symptoms, and past medical history and interval history. + Recognize differences between normal and ... response to emergency situations. + Prepare chart documentation for review and counter signature by the physician. + Determine...care. + Responsible for the conduct of EM sponsored clinical trials including regulatory issues, recruitment and good … more
- AccentCare, Inc. (Columbia, MD)
- …a Palliative Care Nurse Practitioner, you will: + Develop and implement clinical plans of care for patients with chronic and terminal illnesses + Perform patient ... Overview Nurse Practitioner / NP, Palliative Care Location: Columbia,...and maintain valid CPR certification while employed in a clinical role, preferred + Must be a licensed driver… more
- CVS Health (Annapolis, MD)
- …benefit overall claim management. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to ... in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993,… more
- Johns Hopkins University (Baltimore, MD)
- …protocols. **Specific Duties & Responsibilities** + Interview patients and compile patient medical histories to assist in the determination of health status. Perform ... findings, and laboratory values, and make preliminary diagnoses of patients for review by physicians. + Develop care/treatment plans for patients according to… more
- Surgery Care Affiliates (Columbia, MD)
- …do it. Each decision we make is rooted in seven core values: + Clinical quality + Integrity + Service excellence + Teamwork + Accountability + Continuous improvement ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Erickson Living (Catonsville, MD)
- …resident's clinical condition, document findings in the resident electronic medical record, and notify the provider and/or RN when necessary. + Updating ... Sundays What we offer: + Competitive benefits packages including medical , dental, vision, and PTO in accordance with applicable...a timely and professional manner + Participating in the review of clinical indicator reviews - falls,… more
- CareFirst (Baltimore, MD)
- … clinical expertise and critical thinking skills to analyze available clinical information, electronic medical records (EMRs), benefit contracts, mandates, ... working onsite to make rounds with members and hospital staff, participates in clinical knowledge and judgement throughout the review process. Applies sound … more
- CareFirst (Baltimore, MD)
- … clinical expertise and critical thinking skills to analyze available clinical information, Electronic Medical Records (EMRs), benefit contracts, mandates, ... to determine appropriate course of action and level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit… more
- CareFirst (Baltimore, MD)
- …-surgical or similar clinical experience OR 5 years experience in Medical Review , Utilization Management or Case Management at CareFirst BlueCross ... **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate...of appeals and reconsiderations, including Regulatory complaints and External review requests. Accountable for quality review and… more
- CareFirst (Baltimore, MD)
- … clinical expertise and critical thinking skills to analyze available clinical information, electronic medical records (EMRs), benefit contracts, mandates, ... and utilization management including proficiency in MCG to determine medical necessity, appropriate level of care, and case management...course of action and level of care. Applies sound clinical knowledge and judgment throughout the review … more
- Elevance Health (Hanover, MD)
- …Group Clinical Validation Auditor-RN** is responsible for auditing inpatient medical records to ensure clinical documentation supports the conditions and ... DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims. **How...an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and… more