Title: Registered Nurse (HEDIS)
Duration: 12 Months+
Location: Baltimore, MD (Remote Job)
Required Experience:
Should be a LPN / RN OR Licensed Nurse is required (Certification is not required but License is) Compact license
Bachelors degree in nursing is preferred
5 years of HEDIS experience is required if no bachelors then 10 years of experience needed
should have EMR experience EPIC, Clinical, Cerner, Medical records
Working knowledge of managed care and health delivery systems.
Working knowledge of IT and Medical Management systems, familiarity with web-based software application environment and the ability to confidently use the internet as a resource.
Job Details :
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, 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.
This role will also understand the merits of legal or accreditation actions.
Licenses/Certifications:
RN - Registered Nurse / LPN - Should have License, certification is not required
Thomas Mechanical LLC, a leader in HVAC services, is looking for an experienced Sheet Metal Worker III to join our innovative team. The ideal candidate will possess advanced skills in fabricating, installing, and repairing sheet metal products and equipment, such as ducts...
...Job Description UPMC Mercy is currently hiring a full-time Professional Staff Nurse to support its 5F Medical/Surgical Acute Care unit! \n \n 5F is a 16-bed Acute Care Unit specializing in transitioning patients both in and out of the acute care environment....
...in the majestic mountains with a free season pass that opens the doors to adventure at all Alterra Resorts. Your whole family can share this excitement with free skiing for dependents and a range of valuable discounts. It is more than a job; it is an opportunity to embrace...
...largest, privately held Taco Bell franchisees in America. At Border Foods, we work with a people-first mantra. From cooks to cashiers to... .../Dental/Vision benefits offered for all positions - even part-time! -Free food! -Vacation Time (Paid Time Off) -Vacation Donation...
As a Meat Lead at BJs Wholesale Club, you will be an essential member of our team, leading the operations within the Meat Department... ...in meat cutting and a strong understanding of department management. You will oversee the daily operations, maintain quality standards...