Clinical Medical Review Nurse - HEDIS Retrospective Project

Company Description
Lumen SolutionsGroupInc. is a technology consulting Services company based inFlorida. Weprovidea wide array of experienced business and IT professionals supporting clients from solution design to implementation and specialize in professional IT consulting services IT Staffing Business/IT Strategy Business Process Blueprints Enterprise Architecture EnterpriseTransformation.

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 frequenthistorically 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 candidates clinical background and licensing situation.
• Ability to successfully complete a potential HEDIS knowledge assessment .

Education

• Bachelors degree is preferred.
• Candidates without a Bachelors degree may be considered with 10 years of relevant HEDIS experience.

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

Required Experience:

IC