Clinical Medical Review NurseCynet Systems • Baltimore, MD, United States
Clinical Medical Review Nurse
Cynet Systems • Baltimore, MD, United States
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
Job Description:
Pay Range: $37.49hr - $41.49hr
Pay Range: $37.49hr - $41.49hr
- The Clinical Medical Review Nurse is responsible for reviewing, researching, and analyzing professional and institutional claims using nursing clinical judgment, critical thinking, and established medical and corporate policies.
- This role supports accurate claims adjudication, medical policy development, and underwriting activities.
- Receive, research, review, and analyze professional and institutional claims using clinical judgment and medical policies.
- Perform high-level research on actual or potential medical policy topics and assess the impact on existing policies.
- Provide pricing for procedure codes requiring individual consideration or classified as not otherwise specified in CPT manuals.
- Interpret medical and descriptive information using CPT and HCPCS manuals while maintaining current knowledge of coding standards.
- Participate in medical policy meetings, nurses' forums, review sessions, special projects, and task force committees as assigned.
- Perform medical underwriting and risk assessment by reviewing subscriber applications and relevant medical records.
- Three years of acute clinical experience.
- Previous experience in case management, discharge planning, or utilization review.
- Strong clinical judgment and critical thinking abilities.
- Excellent interpersonal and customer service skills.
- bility to work independently and as part of a team.
- Strong organizational skills with attention to detail.
- Proficiency in Microsoft Office applications and web-based technology.
- Excellent verbal and written communication skills.
- Bachelor's degree in Nursing preferred.
- ctive Registered Nurse (RN) state licensure or compact state licensure required upon hire (VA, DC, and/or MD).
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Clinical Medical Review Nurse • Baltimore, MD, United States
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