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Clinical Medical Review Nurse

Ampcus Incorporated

Owings Mills, MD(remote)

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JOB DETAILS
SALARY
$40–$45 Per Hour
SKILLS
Analysis Skills, Business Administration, Business Plan, Business Services, Clinical Medicine, Clinical Nursing, Communication Skills, Consulting, Cost Analysis, Cost Control, Customer Relations, Data Analysis, Health Plan, Healthcare, Leadership, Medical Terminology, Microsoft Excel, Microsoft FAST, Microsoft PowerPoint, Microsoft Word, Physical Demands, Problem Solving Skills, Process Development, Quality Assurance, Quality Management, Registered Nurse (RN), Team Player, Time Management, Trend Analysis, Utilization Management, Work From Home
LOCATION
Owings Mills, MD(remote)
POSTED
30+ days ago

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.
 
 
Job Title: Clinical Medical Review Nurse.
Location: Owings Mills, MD.

 
 
Summary:

  • The Contingent RN supports CareFirst by analyzing high cost claimant and population health data to support utilization review, ad hoc requests, and client reports.
  • This position requires experience excising and understanding medical terminology, analytical expertise, and cross team collaboration in a fast paced, data driven environment. This is an internal, non–client facing role. The timeframe for this position will fluctuate depending on need.
Key Responsibilities:
  • Retrieve and interpret clinical, financial, and population health data across multiple systems.
  • Identify trends, gaps in care, and opportunities for improved health outcomes.
  • Provide clinical expertise and translate complex data into clear insights for internal stakeholders.
  • Support cost containment and quality improvement initiatives through data driven recommendations.
  • Communicate effectively across teams and levels, including leadership.
  • Work independently with minimal supervision while maintaining accuracy and meeting deadlines.
Additional Skills:
  • RN, data analytics, excel, understanding of clinical terminology, cause and effect rationale (inquisitive).
Qualifications:
  • Registered Nurse (RN) – active state or compact license.
  • 4 years’ clinical experience plus 2 years of healthcare data analysis.
  • Proficiency in Excel, Word, PowerPoint; strong analytical and critical thinking skills.
  • Ability to influence and collaborate with stakeholders across the organization.
  • Bachelor’s degree required (or 4 years’ equivalent experience).
  • Preferred: Graduate degree (MSN, MBA, MPH) and experience within a health plan or business focused role.
Role Characteristics:
  • Individual contributor who researches high cost claimants, populates slide decks, and responds to ad hoc requests.
  • Resolves moderately complex problems using established processes and clinical judgment.
  • Frequent cross department communication.
  • Represents the team with professionalism and a collaborative mindset.
  • Remote work environment with minimal physical demands.








Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.

About the Company

A

Ampcus Incorporated

Ampcus Inc is a global technology and business consulting firm specializing in Digital Transforrmation, Big Data, Analytics, Cyber Security, Testing, IV&V, Infrastructure Management and Enterprise Solutions. Ampcus Inc is an SBA 8(a) certified Women and Minority Owned global Provider of broad range of consulting Services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, their goals become our goals. We are an ISO 9000, ISO 20000, ISO 27000 and CMMi Level certified company.

Ampcus consultants have significant business, engineering and technology experience. Our consultants have over 20 years of business experience and an average of over 10 years of engineering and technology experience. This means that the project teams understand how systems work and how the technology impacts the business processes of organizations.

We believe that success of an engagement is determined by strong project management, clear communication and mutual commitment working collaboratively. Our methodology begins by listening to the customer needs, then working with their teams to gain a clear understanding of the requirements, while providing a knowledge transfer of best practices for the organization. As a recognized leader providing customized software services, management and engineering solutions to companies around the world, our ability to deliver is a "granted"​ that makes companies put their trust in us to answer their day-to-day business challenges and put them on a path for greater success. We are the choice for our clients because we look at our clients business from a growth perspective.

Industry: Information Technology and Services

Specialties: Digital Transformation, Big Data and Analytics, Infrastructure Management Services, Testing and IV&V, Cyber Security, Active Directory and E-mail Infrastructure, Project Management, Training, and ERP, CRM. EAI, BI

COMPANY SIZE
500 to 999 employees
INDUSTRY
Staffing/Employment Agencies
WEBSITE
http://www.ampcus.com