Medical Review Quality Specialist
2 days ago
Elite Technical is seeking a Medical Review Quality Specialist to support our Healthcare Payor customer in the Baltimore Area. The successful candidate will be responsible for chart retrieval and conducting thorough medical record reviews using proprietary tools and software within HEDIS measurement/standards.
Key Responsibilities:- Retrieve medical records via EMR or fax request, ensuring compliance with all HIPAA and member confidentiality requirements.
- Conduct Medical Record Abstraction and Research during the Medical Record Review Project.
- Use various software applications to support HEDIS operations by entering data and/or changing chase status for the identified chase(s).
- Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering.
- Ensure compliance with all HIPAA and member confidentiality requirements.
The ideal candidate will have expertise in HEDIS and Quality Measures, with the ability to meet productivity and quality targets, enhance measure compliance, and improve rate submissions according to NCQA guidelines and technical specifications.
This is a remote position, with occasional onsite activities in the Maryland/Baltimore County area. Mandatory onsite training is required for 5 days in January 2025.
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Clinical Review Nurse Specialist
3 weeks ago
Baltimore, Maryland, United States Quality Talent Group Full timeClinical Review Nurse **About the Role** We are seeking a dedicated and experienced Clinical Review Nurse to join our team at Quality Talent Group. As a Clinical Review Nurse, you will play a crucial role in ensuring the accuracy and compliance of our home care service documentation, supporting revenue cycle compliance, and maintaining survey...
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Clinical Medical Review Nurse
2 days ago
Baltimore, Maryland, United States Vega Consulting Solutions, Inc Full timeJob Title: Clinical Medical Review NurseWe are seeking a highly skilled and experienced Clinical Medical Review Nurse to join our team at Vega Consulting Solutions, Inc. As a key member of our Quality Department, you will play a crucial role in ensuring the accuracy and quality of our medical records and data.Key Responsibilities:Conduct thorough HEDIS...
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Clinical Review Nurse
1 month ago
Baltimore, Maryland, United States Quality Talent Group Full timeAbout the Clinical Review Nurse RoleWe are seeking a dedicated and experienced Clinical Review Nurse to join our team at Quality Talent Group. As a Clinical Review Nurse, you will play a crucial role in ensuring the accuracy and compliance of our home care service documentation, supporting revenue cycle compliance, and maintaining survey readiness.Key...
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Clinical Medical Review Nurse Specialist
15 hours ago
Baltimore, Maryland, United States Three Point Solutions Full timeClinical Medical Review Nurse **Job Summary:** We are seeking a highly skilled Clinical Medical Review Nurse to join our team at Three Point Solutions. The successful candidate will be responsible for conducting HEDIS overreads, assisting with medical record retrieval, participating in internal audits, and supporting quality department needs. **Key...
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Hedis Quality Specialist
1 day ago
Baltimore, Maryland, United States Alta It Services Full timeJob Title: Hedis Quality SpecialistAlta IT Services is seeking a skilled Hedis Quality Specialist to support a leading health insurance customer on a 6+ month contract opportunity.Key Responsibilities:Retrieve and review medical records using proprietary tools and software.Conduct thorough chart reviews to ensure compliance with Hedis standards.Collaborate...
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Clinical Medical Reviewer
3 weeks ago
Baltimore, Maryland, United States ICONMA Full timeJob SummaryWe are seeking a highly skilled Clinical Medical Reviewer to join our team at ICONMA. As a Clinical Medical Reviewer, you will play a critical role in ensuring the accuracy and quality of medical records.Key ResponsibilitiesMedical Record Review: Accurately and efficiently review medical records to ensure compliance with HEDIS specifications and...
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Clinical Medical Review Nurse Specialist
3 weeks ago
Baltimore, Maryland, United States Three Point Solutions Full timeJob OverviewThe Clinical Medical Review Nurse will play a crucial role in ensuring the quality and accuracy of medical records. This position requires a strong clinical background and excellent analytical skills to review and correct medical abstracts.Key Responsibilities:Conduct thorough reviews of medical records to ensure accuracy and...
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Utilization Review Specialist
4 weeks ago
Baltimore, Maryland, United States Walker Health Services Full timeJob SummaryWalker Health Services is seeking a highly skilled Utilization Review Specialist to review patient admissions and clinical information for medical necessity and compliance with utilization review guidelines.Key Responsibilities:Review patient admission and clinical information to ensure medical necessity and compliance with state-specific...
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HEDIS Quality Specialist
1 week ago
Baltimore, Maryland, United States ALTA IT Services, LLC Full timeHEDIS Quality Specialist Job DescriptionALTA IT Services, LLC is seeking a skilled HEDIS Quality Specialist to support a leading health insurance customer. The ideal candidate will have extensive knowledge of HEDIS measures and medical record review processes.Key Responsibilities:Retrieve medical records via EMR or fax request, ensuring compliance with HIPAA...
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HEDIS Medical Review Nurse Specialist
2 days ago
Baltimore, Maryland, United States nTech Solutions, Inc. Full timeJob Title: HEDIS Medical Review NurseJob Summary:We are seeking a skilled HEDIS Medical Review Nurse to join our Quality Team at nTech Solutions, Inc. The ideal candidate will have experience in HEDIS reporting and overread processes, with a strong understanding of healthcare quality metrics and data abstraction.Responsibilities:Conduct thorough HEDIS...
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Quality Control Specialist
1 day ago
Baltimore, Maryland, United States MAXIMUS Full timeJob Title: Quality Control SpecialistMaximus is seeking a Quality Control Specialist to join our Veterans Evaluation Services (VES) team. This is a remote opportunity.The Quality Control Specialist is responsible for reviewing Medical Disability Examination (MDE) reports and Disability Benefits Questionnaires (DBQs) generated by medical providers for...
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Clinical Medical Reviewer
3 weeks ago
Baltimore, Maryland, United States ICONMA Full timeJob SummaryWe are seeking a highly skilled Clinical Medical Reviewer to join our team at ICONMA. As a Clinical Medical Reviewer, you will play a critical role in ensuring the accuracy and quality of medical record abstractions performed by our HEDIS abstraction staff.Key ResponsibilitiesMedical Record Over-Reading: Accurately and efficiently over-read...
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Clinical Medical Review Nurse Specialist
3 weeks ago
Baltimore, Maryland, United States Zolon Tech Inc. Full timeJob Title: Clinical Medical Review NurseJob Summary:Zolon Tech Inc. is seeking a skilled Clinical Medical Review Nurse to join our Quality Team. As a key member of our team, you will be responsible for conducting thorough HEDIS overreads in line with NCQA guidelines.Key Responsibilities:Conduct HEDIS overreads in line with NCQA guidelinesHelp with Medical...
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HEDIS Quality Specialist
24 hours ago
Baltimore, Maryland, United States Alta It Services Full timeAlta IT Services is seeking a skilled professional to support a leading health insurance customer as a HEDIS Quality Specialist. This 6+ month contract opportunity requires the individual to conduct thorough medical record reviews using proprietary tools and software.Key Responsibilities:Retrieve and review medical records to ensure accuracy and...
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Clinical Medical Review Nurse Specialist
2 weeks ago
Baltimore, Maryland, United States Three Point Solutions Full timeJob OpportunityPosition: Clinical Medical Review NurseDuration: 6 Months ContractClient: Medical Device Manufacturing CompanyLocation: Baltimore MD 21224Job Summary:The Clinical Medical Review Nurse will report to the Clinical Support Supervisor HEDIS and work as part of the Quality Team. Responsibilities include conducting HEDIS overreads per NCQA...
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HEDIS Medical Review Nurse Specialist
3 weeks ago
Baltimore, Maryland, United States nTech Workforce Full timeJob SummarynTech Workforce is seeking a skilled HEDIS Medical Review Nurse to join our Quality Team. As a key member of our team, you will be responsible for conducting thorough HEDIS overreads in accordance with NCQA guidelines.Key ResponsibilitiesAssist with Medical Record Retrieval for HEDIS and Risk AdjustmentParticipate in internal audits for...
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Clinical Quality Specialist
4 days ago
Baltimore, Maryland, United States TEKsystems Full timeJob Title: Clinical Quality SpecialistWe are seeking a highly skilled Clinical Quality Specialist to join our team at TEKsystems. As a Clinical Quality Specialist, you will play a critical role in ensuring the quality and accuracy of medical records and data.Key Responsibilities:Retrieve medical records via EMR or fax request, ensuring compliance with HIPAA...
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Hedis Quality Specialist
1 day ago
Baltimore, Maryland, United States ALTA IT Services, LLC Full timeJob Title: Hedis Quality SpecialistALTA IT Services, LLC is seeking a highly skilled Hedis Quality Specialist to support a leading health insurance customer. The ideal candidate will have extensive knowledge of HEDIS measures and medical record review processes.Key Responsibilities:Retrieve medical records via EMR or fax request, ensuring compliance with...
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Quality Assurance Specialist
1 day ago
Baltimore, Maryland, United States Medvacon Life Sciences Full timeJob Title: Quality Assurance SpecialistMedvacon Life Sciences is seeking a highly skilled Quality Assurance Specialist to join our team. As a Quality Assurance Specialist, you will be responsible for ensuring the quality and compliance of our products.Key Responsibilities:Review and verify executed batch records of APIs, Drug Products, and secondary...
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Clinical Medical Review Nurse
2 weeks ago
Baltimore, Maryland, United States Vega Consulting Solutions, Inc Full timeJob Title: Clinical Medical Review NurseWe are seeking a highly skilled and experienced Clinical Medical Review Nurse to join our team at Vega Consulting Solutions, Inc.Job Summary:The Clinical Medical Review Nurse will be responsible for conducting thorough medical record reviews to ensure accuracy and compliance with HEDIS guidelines. This role requires a...