Clinical Medical Review Nurse Job at Three Point Solutions, Baltimore, MD

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  • Three Point Solutions
  • Baltimore, MD

Job Description

Job Description

Job Description

Position: Clinical Medical Review Nurse
Duration: 6 Months Contract

Client: Medical Device Manufacturing Company
Location: Baltimore MD 21224

Job Description:
The Clinical Medical Review Nurse (RN/LPN) will report to the Clinical Support Supervisor HEDIS and work as part of the Quality Team. Responsibilities include conducting HEDIS overreads per NCQA guidelines, assisting with medical record retrieval for HEDIS and Risk Adjustment, participating in internal audits, and supporting quality department needs.

Essential Functions:

  • 50% : Over-read HEDIS abstractions, correct errors, and maintain productivity.
  • 25% : Medical record retrieval and abstraction for HEDIS.
  • 25% : Record retrieval for Risk Adjustment and audits during off-season.

Qualifications:

  • 3 years of clinical experience.
  • 5 years of HEDIS and overread experience, or 10 years in HEDIS abstraction/overreads.

Preferred:

  • Nursing degree (Bachelor's, Associate's, or Diploma).
  • 2 consecutive HEDIS seasons with the same company.

Skills:

  • Communication, interpersonal skills, clinical knowledge, and organization.
  • Proficient in Microsoft Office and web-based tools.

Licenses/Certifications:

  • RN/LPN - MD, VA, or DC licensure required.

#ZR

Job Tags

Contract work,

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