Clinical Medical Review Nurse

2 weeks ago

Baltimore, Maryland, United States Charter Global Full time
Job Title: Clinical Medical Review Nurse

Job Summary:

We are seeking a highly skilled Clinical Medical Review Nurse to join our Quality Team. The successful candidate will be responsible for conducting thorough HEDIS overreads, medical record retrieval, and abstraction, as well as participating in internal audits and supporting other needs within the Quality Department.

Key Responsibilities:

  • Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff on a daily basis according to HEDIS specifications and company training guidelines.
  • Complete the over-read process in the Software Application, including comments if errors are found. Correct errors identified through over-read process, including a re-review of charts that may contain similar errors.
  • Identify and report abstraction errors and provide measure re-education with the abstractor.
  • Utilizes various software applications to support HEDIS operations by entering data and / or changing chase status for the identified chase(s).
  • Maintain productivity level as determined by the QI Department.
  • Maintain compliance with all HIPPA and member confidentiality requirements.

Requirements:

  • Must be a RN OR LPN with HEDIS in the recent experience - atleast 5 years with HEDIS - specially HEDIS overreads aspect
  • Medical professional with overreads HEDIS
  • 6 years of overall experience with Nursing - clinical back side nursing 2-3 years - Quality, NCQA
  • Recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer)
  • Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing

Why Join Our Team:

At Charter Global, we value our employees and offer a dynamic and supportive work environment. We are committed to providing our employees with the tools and resources they need to succeed in their roles and to grow and develop their careers.

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