Clinical Medical Review Nurse

Job Description

Job Description

Pay Range: $49.77hr - $54.77hr

Job Overview:

Top Required Skills:

• Current knowledge of clinical practices related to HEDIS and medical record review.
• Strong organizational skills, including the ability to prioritize responsibilities, maintain attention to detail, and shift tasks as needed.
• Experience using Microsoft Office applications, including Excel, Word, and PowerPoint, as well as web-based technology.
• Excellent verbal and written communication skills.
• Strong interpersonal skills, with the ability to work independently and as part of a team.

Purpose:

- The Clinical Medical Review Specialist, a professional with clinical experience, will report to the Clinical Support Supervisor for HEDIS and be part of the Quality Team. The main duties include chart retrieval, using proprietary tools and software to conduct thorough medical record reviews in line with NCQA specifications, retrieval follow-up, and escalating issues as needed. Main duties will be assigned according to experience, knowledge, skills, and abilities. This role requires extensive knowledge of HEDIS measures to accurately and expediently abstract medical records while adhering to HIPAA Privacy and Security standards.

- Additional tasks involve helping with EMR medical record retrieval for HEDIS, contacting provider offices to request or validate facility and provider contact information and record retrieval preference, and/or requesting medical records for the HEDIS project and supporting other needs within the Quality Department.

Responsibilities:

The Clinical Medical Review Specialist, a professional with clinical experience, will report to the Clinical Support Supervisor for HEDIS and be part of the Quality Team.

Benefits:

Our Benefits Include:

• Medical, Dental, and Vision Insurance
• 401(k) Retirement Plan
• Health Savings Account (HSA)
• Disability Insurance (Short-Term and Long-Term)
• Life and AD&D Insurance
• Paid Sick Leave (where required by applicable state or local law)
• Supplemental Insurance Plans
• Identity Theft Protection
• Pet Insurance
• Employee Wellness Programs
• Employee Assistance Program (EAP)
• Career Growth and Professional Development Opportunities

Disclaimer : Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Systems Inc. reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.

About Cynet Systems

Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading technology staffing and workforce solutions company serving Fortune 500 companies, government agencies, and enterprise organizations across the United States and Canada. We deliver agile, scalable talent solutions across IT, engineering, life sciences, clinical, and professional staffing, powered by a high-performing recruitment engine operating across North America and Asia.

As a nationally and locally certified Minority Business Enterprise (MBE), Cynet Systems is committed to helping organizations build high-performing teams while empowering professionals to grow rewarding careers. Our organization is certified to ISO 9001, ISO 14001, ISO 27001, and SOC 2 Type II standards, reflecting our commitment to quality, security, operational excellence, and customer success.