Clinical Medical Review Nurse HEDIS Retrospective Project

Job Description

Job Description

Company Description
Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation. 

Position: Clinical Medical Review Nurse – HEDIS Retrospective Project
Locations: Columbia, MD
Work Arrangement: Primarily Remote | Occasional Provider-Site Visits

Position Overview
We are seeking experienced Clinical Medical Review Nurses to support a HEDIS Retrospective Review Project . This role will focus on medical record retrieval, clinical record abstraction, HEDIS/quality measure review, pain management-related reviews, and potentially conducting overreads. The position is primarily remote , with occasional onsite provider visits. Provider visits are not frequent—historically, there have been only a few site visits during the project. Candidates will be selected for provider-site visits based largely on their proximity to the applicable provider location.

Key Responsibilities

• Perform HEDIS retrospective medical record review and abstraction .
• Review medical records to identify and validate information required for applicable HEDIS and quality measures .
• Conduct clinical/medical record review , including pain management-related reviews.
• Potentially perform overreads/quality validation reviews .
• Conduct regular outreach to provider offices to obtain required medical records.
• Request and retrieve medical records through:
  • Phone
  • Email
  • Fax
  • Provider portals
• Communicate professionally with provider offices regarding medical record requests and follow-ups.
• Ensure accurate and timely abstraction of clinical information.
• Apply HEDIS and quality-measure guidelines when reviewing medical records.
• Support quality assurance activities and additional project requirements as assigned.

 
Required Qualifications

• 3+ years of clinical experience .
• 5+ years of recent/current HEDIS experience , or an equivalent combination demonstrating strong clinical and HEDIS expertise.
• Strong hands-on experience with HEDIS and healthcare quality programs .
• Demonstrated ability to review medical records and identify information relevant to HEDIS/quality measures.
• Current/recent experience performing medical record retrieval and abstraction .
• Comfortable communicating with provider offices and requesting records through phone, email, fax, and provider portals .
• Strong understanding of HEDIS measures and medical record documentation.
• Active applicable clinical license is preferred/required based on the candidate's clinical background and licensing situation.
• Ability to successfully complete a potential HEDIS knowledge assessment .

 
Education

• Bachelor's degree is preferred.
• Candidates without a Bachelor's degree may be considered with 10+ years of relevant HEDIS experience.

 
Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.