Get Hired Faster With COMPANY_NAME!
Don't you ever think you landed here by any accident, You are here because you are searching for something bigger. You know what?
- A better Job
- A better Future
- A better Knowledge
- A better Paycheck
- A greater Path to walk on.
And COMPANY_NAME is here to give you exactly what you've been missing for so long. The reality is that most job seekers chase job postings, but successful job seekers attract job offers by chasing the accurate information. Therefore, that's the shift COMPANY_NAME is going to help you make. Here are the top 10 ideas to up-skill yourself, so lean in to begin:
1: COMPANY_NAME Smart Tools and Direct Employer Connections Help Speed Up Your Hiring Process
COMPANY_NAME is a career-changing advantage that most seekers never get access to. Imagine...
- Instead of applying for job after job and still not getting any callbacks, you suddenly bump into a tool that can do the heavy lifting for you.
- Instead of wondering, "What do employers actually want?", you are getting insights straight from the employer's desk.
- Instead of hoping your resume gets noticed, it’s kept on the table of decision-makers who are hiring right now.
That's the difference COMPANY_NAME makes. Our tools will let you reach employers directly, which automatically speeds up your hiring process.
2: With Better Matches, Real-time Job Alerts, and Direct Employer Responses, COMPANY_NAME Helps Many Candidates Secure Interviews and Job Offers Within 15 to 30 Days!
How does COMPANY_NAME make this possible?
On COMPANY_NAME, you get notified for roles aligned with your profile right from the start. When an employer posts a role that matches your qualifications and skills, you’ll know first. When you apply early, your chances of getting noticed and shortlisted increase by 20%.
COMPANY_NAME also offers direct employer responses—no more waiting for weeks. Here you engage with hiring managers who are actively looking for candidates.
When all these features combine in one place, you move from your first match to your first interview within days. And ultimately, from application to offer—all within 15 to 30 days!
3: The Type of Resume You Need to Get Priority Placement
With COMPANY_NAME, you don’t just need a resume—you need a strategy. A system that pushes your name to the right tables. We’ll show you exactly how the most successful candidates take initiative and get noticed.
4: Browse Full-Time, Part-Time, and Freelancing Roles With COMPANY_NAME
The job market isn’t one-size-fits-all—and your career shouldn’t be either. COMPANY_NAME gives you access to a wide range of opportunities including full-time, part-time, and freelancing roles all in one place.
5: COMPANY_NAME Helps You Grow Your Career
COMPANY_NAME provides insights, tools, and role-matching that help you find the right direction, the right skills, and the opportunities aligned with your ambition.
6: The Easiest Way To Find A Job
COMPANY_NAME cuts the noise, the endless scrolling, and the confusion. With accurate matches, direct employer connection, and real-time updates, you get a clear and simple path from application to interview.
7: Find Roles That Offer Growth, Culture & Benefits
COMPANY_NAME helps you find roles where you grow, feel supported, and thrive—not just survive. With us, you discover opportunities that elevate your professional life.
8: Get Support With Resume, Interviews & Career Planning
COMPANY_NAME provides expert guidance on resumes, interviews, and planning so employers instantly recognize your strengths and value.
9: Your Future Starts Today
COMPANY_NAME gives you everything you need—tools, guidance, and opportunities—to step forward confidently and begin a new chapter where your potential is seen and supported.
10: Get Hired Within 15 to 30 Days With COMPANY_NAME
COMPANY_NAME follows a smart, strategic, and proven approach that gets your profile noticed faster and moves you toward interviews and offers within 15 to 30 days.
Clinical Medical Review Nurse (Remote)
Resp & Qualifications
PURPOSE:
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 post claims medical review for Commercial lines of business. 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. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities.
ESSENTIAL FUNCTIONS:
- Receives, research, 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.
QUALIFICATIONS:
Education Level: High School Diploma or GED.
Licenses/Certifications Upon Hire Required:
- RN - Registered Nurse - State Licensure And/or Compact State Licensure RN-VA, DC and or MD.
Experience: 3 years acute clinical experience, previous case management, discharge planning or utilization review experience.
Preferred Qualifications:
- Bachelor's degree in Nursing.
Knowledge, Skills and Abilities (KSAs)
- Ability to effectively communicate and provide positive customer service to every internal and external customer.
- Strong interpersonal skills. Ability to work independently, as well as a member of a team.
- Current knowledge of clinical practices and related medical policies.
- Strong organizational skills, ability to prioritize responsibilities with attention to detail.
- Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology.
- Must possess excellent verbal and written communication skills.
- 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.
Salary Range: 67,320 - 133,705
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
#LI-SS1
