- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes ... regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal… more
- CareFirst (Baltimore, MD)
- …+ Reviews Clinical Appeals and Grievances documentation written by the clinical appeals nurse and non- clinical supporting team members within ... & Qualifications** **PURPOSE:** The role of the Quality Review Nurse (RN) is to evaluate clinical quality...evaluate clinical quality and procedures within the Clinical Appeals & Grievance Department Government Programs… more