Clinical Medical Review Nurse - HEDIS Retrospective Project

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. #J-18808-Ljbffr Lumen Solutions Group Inc.