Clinical Medical Review Nurse

Ampcus Inc. • Owings Mills, MD

3d • Remote

About The Position

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. The role is an individual contributor who researches high‐cost claimants, populates slide decks, and responds to ad‐hoc requests. This role resolves moderately complex problems using established processes and clinical judgment. It involves frequent cross‐department communication and representing the team with professionalism and a collaborative mindset.

Requirements

• 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).

Nice To Haves

• Graduate degree (MSN, MBA, MPH)
• Experience within a health plan or business‐focused role.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level