Clinical Medical Review Nurse Specialist

17 hours ago


Baltimore, Maryland, United States Three Point Solutions Full time

Clinical 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 Responsibilities:**

* Conduct HEDIS overreads per NCQA guidelines to ensure accuracy and quality
* Assist with medical record retrieval for HEDIS and Risk Adjustment
* Participate in internal audits to ensure compliance and quality
* Support quality department needs to ensure seamless operations

**Requirements:**

* 3 years of clinical experience
* 5 years of HEDIS and overread experience, or 10 years in HEDIS abstraction/overreads
* Nursing degree (Bachelor's, Associate's, or Diploma)
* Proficient in Microsoft Office and web-based tools
* RN/LPN - MD, VA, or DC licensure required

**What We Offer:**

* Competitive salary and benefits package
* Opportunities for professional growth and development
* Collaborative and dynamic work environment

**How to Apply:**

If you are a motivated and experienced Clinical Medical Review Nurse looking for a new challenge, please submit your application to us today.



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