Clinical Medical Review Nurse Specialist
1 week ago
Position: Clinical Medical Review Nurse
Duration: 6 Months Contract
Client: Medical Device Manufacturing Company
Location: Baltimore MD 21224
Job 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 guidelines, assisting with medical record retrieval for HEDIS and Risk Adjustment, participating in internal audits, and supporting quality department needs.
Key Responsibilities:
- Conduct HEDIS overreads per NCQA guidelines.
- Assist with medical record retrieval for HEDIS and Risk Adjustment.
- Participate in internal audits.
- Support quality department needs.
Requirements:
- 3 years of clinical experience.
- 5 years of HEDIS and overread experience, or 10 years in HEDIS abstraction/overreads.
Preferred Qualifications:
- Nursing degree (Bachelor's, Associate's, or Diploma).
- 2 consecutive HEDIS seasons with the same company.
Skills:
- Communication, interpersonal skills, clinical knowledge, and organization.
- Proficient in Microsoft Office and web-based tools.
Licenses/Certifications:
- RN/LPN - MD, VA, or DC licensure required.
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