Health Services - Nurse, Clinical Medical Review

Job Description

Job Description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title: Health Services - Nurse, Clinical Medical Review

Location(s): MD, DC, VA, PA, or DE

Job Summary:

The Clinical Medical Review Specialist (a professional with clinical experience) will report to the Clinical Support Supervisor – 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, all 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.

Key Responsibilities:

• Conduct thorough medical record reviews using proprietary tools and software.
• Ensure compliance with NCQA specifications and HIPAA Privacy and Security standards.
• Assist with EMR Medical Record Retrieval for HEDIS.
• Contact provider offices for facility and provider contact information and record retrieval preferences.
• Support other needs within the Quality Department as required.

Required Qualifications:

• Bachelor’s degree in Nursing, Associate’s degree in Nursing, or Diploma in Nursing, or 10 years of relevant HEDIS abstraction and/or overread experience.
• 3 years of clinical experience and 5 years of HEDIS experience.
• Proficiency with Microsoft Office, including Excel, Word, PowerPoint, Microsoft Teams, and Outlook.
• Experience retrieving medical records from EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra.

Benefits Overview:

• Health & Wellness: Comprehensive pre-tax health, dental, and vision insurance options.
• Life Insurance: Group term life insurance and voluntary life insurance coverage.
• Retirement Savings: 401(k) retirement savings plan to help you plan for your future.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.