Clinical Medical Review Nurse

KMM Technologies • Columbia, MD

1d • Hybrid

About The Position

The client is seeking a Clinical Medical Review Nurse/Specialist with a clinical background (RN/LPN or nursing degree) to support HEDIS quality reporting and medical record review and retrieval work experience. This role requires deep HEDIS knowledge, adherence to NCQA specifications and HIPAA standards, and accurate, efficient medical record abstraction, overread, and chart retrieval. Candidates must be highly organized, detail-oriented, able to prioritize and shift tasks, and proficient in Microsoft Office, Teams, Outlook, and EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra. The client also wants excellent verbal/written communication and interpersonal skills to contact provider offices, request or validate records, escalate issues, and work both independently and collaboratively.

Requirements

• RN/LPN or nursing degree
• 10 years of recent payer/health insurance/HEDIS vendor abstraction or overread experience
• At least two recent consecutive HEDIS seasons at the same company
• Proficiency in Microsoft Office, Teams, Outlook
• Proficiency in EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra
• Excellent verbal/written communication and interpersonal skills
• Ability to work independently and collaboratively

Nice To Haves

• Preferred HEDIS overread experience

Responsibilities

• Support HEDIS quality reporting
• Medical record review and retrieval
• Medical record abstraction
• Overread of medical records
• Chart retrieval
• Contact provider offices to request or validate records
• Escalate issues

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree