HEDIS Clinical Medical Review Nurse

Pay Rate: $41/hr on W2

Must-Have:

• Must have a Laptop/computer with internet to work from home.

• Comfortable providing a Photo ID Copy

Terms of Employment:

• Contract Duration: 5 months

• Work Location: Primarily Remote (Hybrid focus for candidates residing in MD, DC, or VA; PA and DE considered). Requires mandatory on-site training in Meriwether, MD the week of December 14th and occasional travel to provider sites.

Overview:

Work with a leading healthcare organization as a Clinical Medical Review Nurse supporting the annual HEDIS retrospective project. In this role, you will drive medical record retrieval, abstraction, provider outreach, and quality measure management. Joining a collaborative and quality-focused team, you will play a critical role in evaluating medical records to ensure organizational compliance and high standards of care.

Key Responsibilities:

• Conduct medical record retrieval, abstraction, pen management, and quality measure overreads for HEDIS retrospective projects.

• Perform daily outreach to provider offices via phone, email, fax, and remote EMR portal access to request and secure medical records.

• Conduct occasional local on-site visits to provider offices to retrieve paper records when necessary.

• Complete comprehensive onboarding, orientation, and environment navigation virtual trainings during the first two weeks of assignment.

• Utilize EMR systems (such as Epic, Athena) and internal software tools to review clinical documentation accurately.

• Collaborate closely with quality managers and team members in a proactive, remote team environment.

Required Qualifications:

• Minimum 3 years of clinical background/experience combined with at least 5 years of recent HEDIS and quality measures experience (or 10 years of recent relevant HEDIS experience for candidates without a Bachelor's degree or RN/LPN license, such as CNAs, Medical Billers, or Coders).

• Active RN, LPN, or CNA licensure/certification (Compact state licenses accepted).

• Demonstrated experience in medical record retrieval, abstraction, and direct provider outreach.

• Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and Microsoft Teams.

• Reside within reasonable proximity to the MD/DC/VA area (PA and DE considered) with willingness to travel locally to provider sites as needed.

• Availability to attend mandatory, on-site, in-person training at the Meriwether office the week of December 14th.

• Strict availability during the project blackout period from February through April (no extended planned vacations/absences).

Preferred Qualifications:

• Prior experience performing HEDIS overreads and high-level quality audits.

• Familiarity with major EMR systems such as Epic and Athena.

• Dual-monitor remote work setup established.