Clinical Medical Review Nurse – HEDIS Retrospective Project
Lumen Solutions Group Inc•Columbia, MD
•Hybrid
About The Position
We are seeking experienced Clinical Medical Review Nurses to support a HEDIS Retrospective Review Project. This role will focus on medical record retrieval, clinical record abstraction, HEDIS/quality measure review, pain management-related reviews, and potentially conducting overreads. The position is primarily remote, with occasional onsite provider visits. Provider visits are not frequent—historically, there have been only a few site visits during the project. Candidates will be selected for provider-site visits based largely on their proximity to the applicable provider location.
Requirements
- 3+ years of clinical experience.
- 5+ years of recent/current HEDIS experience, or an equivalent combination demonstrating strong clinical and HEDIS expertise.
- Strong hands-on experience with HEDIS and healthcare quality programs.
- Demonstrated ability to review medical records and identify information relevant to HEDIS/quality measures.
- Current/recent experience performing medical record retrieval and abstraction.
- Comfortable communicating with provider offices and requesting records through phone, email, fax, and provider portals.
- Strong understanding of HEDIS measures and medical record documentation.
- Ability to successfully complete a potential HEDIS knowledge assessment.
Nice To Haves
- Active applicable clinical license is preferred/required based on the candidate's clinical background and licensing situation.
Responsibilities
- Perform HEDIS retrospective medical record review and abstraction.
- Review medical records to identify and validate information required for applicable HEDIS and quality measures.
- Conduct clinical/medical record review, including pain management-related reviews.
- Potentially perform overreads/quality validation reviews.
- Conduct regular outreach to provider offices to obtain required medical records.
- Request and retrieve medical records through: Phone, Email, Fax, Provider portals.
- Communicate professionally with provider offices regarding medical record requests and follow-ups.
- Ensure accurate and timely abstraction of clinical information.
- Apply HEDIS and quality-measure guidelines when reviewing medical records.
- Support quality assurance activities and additional project requirements as assigned.
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What This Job Offers
Career Level
Mid Level
