Vega Consulting Solutions, Inc. is searching for a Clinical Medical Review Nurse for 6 month Contract opportunity with our direct client. This is a hybrid position and the resource must reside within the service area. Candidates must be located in the Baltimore Maryland area. Sponsorship is not available.
The Clinical 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, 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. This role will also understand the merits of legal or accreditation actions.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions.
Experience: 3 years acute clinical experience, previous case management, discharge planning or utilization review experience
Bachelor's degree in Nursing
Ability to effectively communicate and provide positive customer service to every internal and external customer, Proficient
Strong interpersonal skills. Ability to work independently, as well as a member of a team , Advanced
Current knowledge of clinical practices and related medical policies., Proficient
Strong organizational skills, ability to prioritize responsibilities with attention to detail., Proficient
Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology., Proficient
Must possess excellent verbal and written communication skills. , Advanced
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Licenses/Certifications
RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD Upon Hire Req
LPN_Licensed Practical Nurse
If your back ground matches the above skill set and you are open to Contract opportunities, please select Apply Now and a Vega Staffing Specialist will reach out to you.