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HEDIS Medical Review Nurse
nTech WorkforceBaltimore, MD, US12 hours ago
Job type
- Full-time
- Temporary
Job descriptionConduct thorough medical record reviews to collect and validate data against HEDIS performance measures. Abstract relevant clinical data from electronic and paper medical records and accurately enter findings into HEDIS electronic database software. Retrieve medical records via Electronic Medical Record (EMR) systems or fax requests, ensuring strict compliance with HIPAA and member confidentiality requirements. Travel to provider offices in the DMV area (DC, Maryland, Virginia) as needed to retrieve medical records, and potentially travel between multiple offices in one day. Perform outreach to provider offices, primarily outbound phone calls, to request records, validate facility / provider addresses, and clarify documentation discrepancies, with the expectation of receiving call-backs. Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering. Document all outreach and follow-up efforts and maintain established daily productivity and accuracy levels. Collaborate with the Quality Improvement team to identify trends in abstraction and resolve documentation issues, providing feedback to abstractors as needed. Maintain a flexible approach to problem-solving and be able to quickly adapt to changing priorities and processes during the HEDIS season. Active Registered Nurse (RN) or Licensed Practical Nurse (LPN) license. A minimum of three (3) years of clinical experience with a strong clinical knowledge base and understanding of medical terminology, such as blood pressure (BP) and A1C. In lieu of an Associate's or Bachelor's degree in Nursing, ten (10) years of recent HEDIS abstraction / overread experience on the payer / health insurance side or with a HEDIS vendor is required. A minimum of five (5) years of HEDIS experience, which is mandatory for this project. Advanced proficiency in the Microsoft Office Suite, including Excel, Word, PowerPoint, Teams, and Outlook. Experience working with Electronic Medical Record (EMR) systems, particularly Epic, eClinicalWorks, and Cerner. Demonstrated critical thinking and strong analytical skills with the ability to "think outside the box" to interpret ambiguous medical records and apply complex HEDIS definitions. Exceptional attention to detail and ability to follow complex, step-by-step instructions and proper procedures accurately. Strong organizational and time management skills to manage a heavy workload and strict seasonal deadlines. Excellent written and verbal communication skills for both internal team communication and external interaction with provider offices. Strong interpersonal skills and the ability to work effectively as an independent contributor and as a member of a team. Must reside within the District of Columbia, Maryland, or Virginia (DMV) area and have reliable transportation for the required in-person training and travel to provider offices. Required attendance for the entire six-month contract; no time-off requests will be authorized due to the critical nature of the HEDIS season. Associate's Degree (AA) or Bachelor's Degree (BSN) in Nursing. At least two (2) recent, consecutive HEDIS seasons with the same employer.
Job Description
Terms of Employment
- W2, Contract, 6 Months
- Primarily remote with candidates being required to reside in MD, DC, PA, VA, or DE. There will be a 3-day training period onsite in Canton, MD. Infrequent travel required to onsite provider offices
- Full-Time, M-F, 8 : 00am to 5 : 00pm
Overview & Key Responsibilities
Our client is seeking a HEDIS Medical Review Nurse to play a vital role in their annual Healthcare Effectiveness Data and Information Set (HEDIS) project. This is a critical seasonal assignment that directly impacts healthcare quality scores and regulatory compliance. The ideal candidate is a highly organized and clinically knowledgeable professional with extensive HEDIS abstraction experience. The role involves the thorough review and abstraction of medical records, close collaboration with provider offices, and utilization of advanced technology skills to ensure data accuracy and quality measure compliance. This is an excellent opportunity for an experienced nurse to leverage their clinical knowledge and critical thinking skills in a fast-paced, team-focused environment.
Key responsibilities include :
Required Skills & Experience
Preferred Skills & Experience
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Medical Review Nurse • Baltimore, MD, US
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