HEDIS Clinical Medical Review Nurse

Terms of Employment:

• Contract Duration: 5 months
• Work Location: Primarily Remote (Hybrid focus for candidates residing in MD, DC, or VA). Requires mandatory on-site training in Meriwether, MD, the week of December 14th and occasional travel to provider sites.

Check below to see if you have what is needed for this opportunity, and if so, make an application asap.

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 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. xhyhwjd
• Dual-monitor remote work setup established.