HEDIS Clinical Medical Review Nurse

HEDIS Clinical Medical Review Nurse

Location: Columbia, MD Type: Contract Compensation: $41.49 Work Model: Hybrid onsite and remote Hours: 40.0

Responsibilities

• Conduct thorough medical record reviews in accordance with NCQA specifications using proprietary tools and software.
• Retrieve and follow up on medical records, escalating issues as needed.
• Support EMR Medical Record Retrieval for HEDIS projects.
• Contact provider offices to request or validate facility and provider contact information and record retrieval preferences.
• Assist with other tasks within the Quality Department related to HEDIS data collection and abstraction.

Requirements

• Registered Health Information Associate/Registered Health Information Technician, Nursing, or a related clinical or healthcare field.
• Candidates qualifying in lieu of a degree must have 10 years of recent, relevant HEDIS medical record abstraction and/or overread experience within a payer, health insurance, or HEDIS vendor setting.
• 3 years of clinical experience and 5 years of HEDIS experience.
• RN or LPN with experience supporting HEDIS reporting and abstraction processes.
• Proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook) and web-based technology.
• Experience retrieving medical records from EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra.
• Ideal candidates reside in or near MD, DC, VA, PA, or DE.
• Will attend in-person training at CareFirst's Merriweather office in December 2026.

System One, and its subsidiaries including Joul and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.