Clinical Medical Review Nurse

KMM Technologies, Inc.; Columbia (MD); Hybrid; USD 70,000 - 100,000; Full time

Job summary

KMM Technologies, Inc. is seeking a Clinical Medical Review Nurse to support HEDIS quality reporting and medical record review. The candidate will retrieve and abstract records while ensuring HIPAA compliance and NCQA alignment.

The role requires strong organizational and communication skills, proficiency with major EMR systems, and experience with providers to validate records and escalate issues as needed.

Qualifications

• RN/LPN or nursing degree with clinical background.
• Deep NCQA/HEDIS knowledge and HIPAA adherence required.
• Proficient in medical record abstraction and chart retrieval with accurate overread.

Responsibilities

• Support HEDIS quality reporting and medical record review.
• Perform retrieval, abstraction, overread, and reporting per NCQA specs.
• Communicate with providers to request/validate records and resolve issues.

Skills

HEDIS knowledge

NCQA specifications

HIPAA compliance

Medical record abstraction

EMR platforms

Microsoft Office

Provider communication

Education

Nursing degree (RN/LPN)

Tools

Epic

eClinicalWorks

Athena

Cerner

Allscripts

Tebra

Job description

Position: Clinical Medical Review Nurse

Location: Columbia, MD - Hybrid - (Once/Twice in a Week Meeting in Office)

Duration: 6+ Months

Interview Mode: 2 Interviews (One Virtual and One In-person at Columbia Office)

SKILLS :

RN/LPN or Nursing, Clinical Medical Review, HEDIS, medical records and EMR Platform

NOTE:

Looking for someone who is a RN/LPN/Medical Review Nurse or equivalently experienced HEDIS abstraction/overread professional with deep NCQA/HEDIS knowledge, payer or vendor-side medical record review experience across at least two recent consecutive HEDIS seasons, strong organizational and communication skills, and proficiency in Microsoft Office and major EMR platforms to support chart retrieval, accurate abstraction, and HIPAA-compliant quality reporting.

Job Description:

• The client is seeking a Clinical Medical Review Nurse/Specialist with a clinical background (RN/LPN or nursing degree) to support HEDIS quality reporting and medical record review and retrieval work experince .
• This role requires deep HEDIS knowledge, adherence to NCQA specifications and HIPAA standards, and accurate, efficient medical record abstraction, overread, and chart retrieval.
• Candidates must be highly organized, detail-oriented, able to prioritize and shift tasks, and proficient in Microsoft Office, Teams, Outlook, and EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra.
• The client also wants excellent verbal/written communication and interpersonal skills to contact provider offices, request or validate records, **escalate** issues, and work both independently and collaboratively.
• Qualifications include a nursing degree or 10 years of recent payer/health insurance/HEDIS vendor abstraction or overread experience, with at least two recent consecutive HEDIS seasons at the same company and preferred HEDIS overread experience.