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Clinical Review Nurse Job in Columbia, Maryland

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Job Title: Clinical Review Nurse

Employer:CareFirst BlueCross BlueShield
Job Location:Partial Remote
Skills:See job description
Required Certifications:Licensed Registered Nurse
Preferred Certifications:COC,CPC
Required Experience:3 to 4 years
Location: Columbia 21046, MD, US
Date Posted:8/27/2021
  • Receives, researches, reviews and analyzes professional and institutional claims using critical thinking, nursing clinical judgment and corporate/medical policies for claims processing and/or adjudication, Performs high-level research on topics identified as actual or potential medical policies. Assesses and communicates impact of information on medical policy.
  • Provides pricing of procedure codes which require individual consideration or are listed as “not otherwise classified” in CPT manual. Interprets the descriptive or medical information utilizing the CPT and HCPCS manuals. Keeps up-to-date on coding rules and standards.
  • Participates in medical policy meetings, nurses' forums, and review sessions with Medical and Dental directors, special projects and task forces committees as assigned.


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