Clinical Medical Review Nurse
Baltimore, MD
Experience: 3
Category: Healthcare
Contractor Work Model: Hybrid
Brand: System One
Job ID: 348673
Date Posted: 04/03/2026
Shortcut: http://jobs.systemone.com/9YWaSJ
Job Title: Clinical Medical Review Nurse
Location: Baltimore, MD
Type: Contract
Compensation: $41.50/HR
Contractor Work Model: Hybrid
Purpose
The Clinical Medical Review Nurse conducts pre? and post?claim medical reviews of professional and institutional claims and provider appeals to determine benefit eligibility and support accurate claims adjudication. This role applies clinical judgment, medical policy, and coding standards to assess medical necessity, appropriateness, and medical risk, while supporting medical policy development and regulatory compliance.
Essential Duties and Responsibilities
- Review, research, and analyze professional and institutional claims requiring medical review, applying clinical expertise, critical thinking, and medical policy to support claims processing and adjudication.
- Conduct pre? and post?payment medical reviews, including complex or escalated claims and provider appeals.
- Evaluate medical documentation and supporting records to determine medical necessity, appropriateness, and benefit eligibility.
- Perform clinical research on identified issues to support medical policy development, interpretation, and updates.
- Provide pricing recommendations for procedure codes requiring individual consideration or classified as unlisted or not otherwise specified, utilizing CPT, HCPCS, and current coding guidelines.
- Participate in medical policy meetings, interdisciplinary forums, review sessions, and assigned special projects.
- Perform medical underwriting and risk assessment by reviewing enrollment applications and medical records to evaluate acceptable medical risk.
- Maintain current knowledge of clinical practices, medical policies, coding standards, and regulatory requirements.
Qualifications
Required Experience (RN and LPN)
- Minimum of three years of acute clinical nursing experience
- Prior experience in utilization review, medical review, case management, or discharge planning
RN (Registered Nurse) Qualifications
Education
- Associate or Bachelor’s degree in Nursing (BSN preferred)
Licensure
- Active RN license in state of practice or compact state
- Multi?state licensure preferred (MD, DC, VA)
LPN (Licensed Practical Nurse) Qualifications
Education
- Graduate of an accredited Practical Nursing program
Licensure
- Active LPN license in state of practice or compact state
- Multi?state licensure preferred (MD, DC, VA)
Additional LPN Preferences
- Ambulatory, utilization review, or non?bedside clinical experience preferred
Knowledge, Skills, and Abilities
- Strong clinical judgment and critical?thinking abilities
- Excellent verbal and written communication skills
- Ability to work independently and collaboratively within a team environment
- Strong organizational skills with the ability to manage competing priorities and meet deadlines
- Proficiency in Microsoft Office applications and web?based systems
- Experience working with electronic medical records (EMR) systems
- Ability to consistently provide professional, solutions?focused customer service in a fast?paced environment
Additional Requirements
- Must disclose any debarment, exclusion, or other conditions that impact eligibility to perform work related to federally funded healthcare programs
- Ability to work effectively in a fast?paced environment with changing priorities, deadlines, and workloads
- Ability to manage multiple internal and external service demands while meeting performance expectations
System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
#M-1
#LI-AJ1
Ref: #851-Rockville-S1
-
Documentation Specialist
Gages Lake, IL
Job Title: Documentation Specialist Location: Gages Lake, IL Compensation: $28.62 Type: Contract Contractor Work Model: On-Site Hours: 7am-3:30pm Overview Leading healthcare company looking for an experienced Documentation Specialist. Ideal candidates ...
Date Posted: 03/27/2026 Recommended
-
Change Control & Document Management Specialist
las angelos, CA
Job Title: Change Control & Document Management Specialist Location: Los Angeles, CA Type: 6 month contract Compensation: $37-43/hr depending on qualifications Contractor Work Model: Onsite Hours: M-F, 8am-4:30pm Overview This role supports quality ope...
Date Posted: 03/27/2026 Recommended
-
Labeling Specialist
Minneapolis, MN
Job Title: Labeling Specialist Location: Minneapolis, MN Type: Contract Compensation: $23-$32.66 Contractor Work Model: Remote Hours: 16-24 hours per week Overview Leading food manufacturing and marketing company looking for an experienced Labeling Spe...
Date Posted: 03/26/2026 Recommended
-
Corporate Contracts Manager II
Alameda, CA
Job Title: Corporate Contracts Manager II Location: Alameda, CA Type: Contract Compensation: $55/hour Contractor Work Model: Onsite Responsibilities Draft, negotiate, and manage a wide variety of agreements supporting clinical development and R&D activ...
Date Posted: 03/31/2026 Recommended
-
Manufacturing Associate (Downstream)
Rockville, MD
Job Title: Manufacturing Associate (Downstream) Location: Rockville, MD Type: Contract Compensation: $20.00 - $26.00 Hours: 6AM-2:30PM, sometimes until 4:30 or 5:00, occasional holiday work, no weekend work at this time Overview Growing Biopharmaceutic...
Date Posted: 03/19/2026 Recommended
-
Customer Service Representative
Pittsburgh, Pennsylvania
Job Title: Customer Service Representative Location: Pittsburgh, Pennsylvania Hours / Schedule: 1st shift, Monday - Friday, onsite Type: Contract Responsibilities Plans and executes expedient and efficient processing of customer orders in the SAP syste...
Date Posted: 01/09/2026 Recommended
-
Lead Packaging Technician 2nd shift
Monmouth Junction, New Jersey
Job Title: Lead Packaging Technician 2nd shift Location: Monmouth Junction, New Jersey Type: Contract To Hire Compensation: $23-$26/Hour, Plus Differential Contractor Work Model: Onsite Hours: M-Th, 3p-11p Job Description Support and assist with packag...
Date Posted: 01/23/2026 Recommended
-
QA Inspector
Andover, MA
Job Title: QA Inspector Location: Andover, MA Type: Contract Compensation: $46.88 Contractor Work Model: Hybrid – onsite and remote Hours: 40.0 Overview Leading pharmaceutical company looking for an experienced QA Inspector. Ideal candidates should hav...
Date Posted: 03/24/2026 Recommended
-
Laboratory Support
Ames, IA
Job Title: Laboratory Support Location: Ames, Iowa Type: Contract Compensation: $23.33 Contractor Work Model: Onsite Hours: 8am-5pm Overview Leading pharmaceutical company looking for an entry level Laboratory Support. Ideal candidates should have a Ba...
Date Posted: 03/25/2026 Recommended
-
MSAT Associate - Manufacturing Technology
Rockville, MD
Job Title: MSAT Associate - Manufacturing Technology Associate Location: Rockville, MD Type: Contract Compensation: $32-$40/hour Schedule: Monday - Friday 8:30am-5:30pm Overview Biopharmaceutical Company is seeking a MSAT Associate to join their team i...
Date Posted: 03/25/2026 Recommended
-
Manufacturing Associate
Novato, CA
Job Title: Manufacturing Associate Location: Novato, CA Hours/Schedule: Alternating Saturdays, Sunday–Tuesday, 6:00 PM – 7:00 AM Compensation: $25-28/hr depending on qualifications Type: 6 month contract Overview The Manufacturing Associate supports co...
Date Posted: 03/17/2026 Recommended
-
Quality Control Analyst II
Piscataway, NJ
Job Title: Quality Control Analyst II Location: Piscataway, NJ Type: Direct Hire Compensation: $75,000 - $82,000 Contractor Work Model: Onsite Hours: 8:30AM-5:00PM Monday-Friday (with occasional early/late hours during production runs) Responsibilities...
Date Posted: 03/31/2026 Recommended
-
Pharmacy Technician
Indianapolis, IN
Job Title: Pharmacy Technician Location: Indianapolis, IN Hours: Mon - Fri 8am - 5pm Max Pay Rate: $25.00/hr Type: Contract, Potential for extension or conversion to permanent Responsibilities We are seeking a detail-oriented and dependable Pharmacy Te...
Date Posted: 03/12/2026 Recommended
-
Project Coordinator
Raritan, NJ
Job Title: Project Coordinator Location: Raritan, NJ Type: Contract Compensation: $65,000 - $70,000 depending on experience Contractor Work Model: Hybrid Hours: 40.0 Responsibilities Accurately input data, manage, and maintain documentation related to ...
Date Posted: 04/02/2026 Recommended
-
Associate Scientist Neuroscience
Tarrytown, NY
Job Title: Associate Scientist Neuroscience Location: Tarrytown, NY Type: Contract Compensation: $38.00 - $45.00 per hour Contractor Work Model: Onsite Hours: 8 AM - 5 PM M-F Responsibilities Support preclinical research in the Neurotherapeutics area w...
Date Posted: 03/16/2026 Recommended
-
MLR Coordinator
Bryn Mawr, Pennsylvania
Job Title: MLR Coordinator Location: Bryn Mawr, Pennsylvania Type: Contract Compensation: $48.00 - $62.50 hourly Contractor Work Model: Remote Hours: 40 hours per week Security Clearance: Not specified Overview: Global Medical Device & Technology Compa...
Date Posted: 02/24/2026 Recommended
-
Clinical Rater
Redding, California
Title: Clinical Rater Location: Redding, California Contract: 12 month (option to extend) Hours - Ad-hoc as needed, may include some weekends, you will be aware of the schedules in advance 100% Onsite Pay Range: $60 - $90/hr W2 - commiserative with exp...
Date Posted: 03/24/2026 Recommended
-
Material Handler
Frederick, MD
Job Title: Material Handler Location: Frederick, MD Type: 12-month contract; possible conversion Pay: $20–25/hr Responsibilities: Manage the receipt, storage, and distribution of materials within the warehouse facility. Ensure inventory accuracy throug...
Date Posted: 03/27/2026 Recommended
-
Packaging Material Handler 1st shift
Monmouth Junction, New Jersey
Job Title: Packaging Material Handler - 1st Shift Location: Monmouth Junction, New Jersey Type: Contract to Hire Compensation: $22-$25/hour (based on experience) Contractor Work Model: Onsite Hours: Monday–Thursday | 5:00 AM – 3:00 PM (10-hour shifts) ...
Date Posted: 01/27/2026 Recommended
-
2nd Shift Packaging Technician
Edison, NJ
Job Title: Packaging Technician - 2nd Shift Location: Monmouth Junction, New Jersey Type: Contract to Hire Compensation: $17-$19/Hour +$1.50 shift differential Contractor Work Model: Onsite Hours: Mon-Thu, 3pm - 1am Position Summary We are seeking a Pa...
Date Posted: 01/09/2026 Recommended
-
Manufacturing Associate - Production Support
Rockville, MD
Job Title: Manufacturing Associate - Biopharmaceuticals Location: Rockville, MD Type: 12 Month Contract potential for hire Compensation: $32.00 - $40.00 Overview Biopharmaceutical Company is seeking an experienced Manufacturing Associate to join their ...
Date Posted: 03/19/2026 Recommended
-
Warehouse Technician – Medical Device
Jersey City, NJ
Job Title: Warehouse Technician - Medical Device Location: Jersey City, NJ (Note: No free on-site parking. Garage parking available at $20/day. Public transportation via PATH or NJ Transit bus routes is preferred.) Hours / Schedule: Monday - Friday, 9a...
Date Posted: 03/25/2026 Recommended
-
QA Complaint Associate
East Windsor, New Jersey
Job Title: QA Product Complaint Coordinator Location: East Windsor, NJ Type: Contract Compensation: $25.00 - $35.00 per hour Contractor Work Model: Onsite Hours: 8:30am - 5:30pm Responsibilities Handle product complaints, including initiating, receivin...
Date Posted: 03/17/2026 Recommended
-
USA - Medical Reviewer - III - USD
Cambridge, MA
Job Title: USA - Medical Reviewer - III - USD Location: Fully Remote - Must be based in US Type: Contract - 1 year Compensation: $80.00 - $115/hr Overview Exciting opportunity to work direct with a leading global pharmaceutical company! If you have an ...
Date Posted: 03/19/2026 Recommended
-
Quality Process Technician
Cranbury, NJ
Job Title: Quality Process Technician Location: Cranbury, NJ Type: Direct Hire Compensation: $24 - $24 hourly Contractor Work Model: Onsite Hours: 7 PM- 3:30 AM M-F (Overtime available on a rotating basis) Responsibilities Responsible for conducting co...
Date Posted: 02/18/2026 Recommended
-
Training Assistant
Indianapolis, IN
Job Title: Training Assistant Location: Indianapolis, IN Hours: Mon - Fri 8am - 5pm Contractor Work Model: Onsite Compensation: $25.25/hr Type: Contract, Potential for extension or conversion to permanent Responsibilities Support learning operations ac...
Date Posted: 03/25/2026 Recommended
-
Toxicology Student
Princeton, NJ
Job Title: Toxicology Student Location: Princeton, NJ (Remote) Type: Contract Compensation: $30-40/hr Hours: M- F 8:30p-4:30p Responsibilities Conduct ingredient and product toxicological risk assessments Perform literature search, data collection and ...
Date Posted: 03/19/2026 Recommended
-
Facility Maintenance Mechanic
Cranbury, NJ
Job Title: Facility Maintenance Mechanic Location: Cranbury, NJ Hours / Schedule: Monday–Friday (8:00 AM – 5:00 PM), some flexibility for early / late shifts and occasional weekends as needed Type: Contract To Hire Compensation: $34.50 per hour pending...
Date Posted: 03/31/2026 Recommended
-
Scientist II
Ridgefield, CT
Job Title: Scientist II Location: Ridgefield, CT Type: Contract Compensation: $40.04 Contractor Work Model: Onsite Hours: 40.0 hours per week Overview Leading pharmaceutical company looking for an experienced Scientist II. Ideal candidates should have ...
Date Posted: 04/03/2026 Recommended
-
Packaging Technician 1st shift
Monmouth Junction, New Jersey
Job Title: Packaging Technician (1st shift) Location: Monmouth Junction, New Jersey Type: Contract To Hire Compensation: $18/hour Contractor Work Model: Onsite Schedule: Monday through Thursday (5AM to 3PM) Packaging Technician (1st Shift) The Packagin...
Date Posted: 01/23/2026 Recommended