Hybrid HEDIS Nurse Reviewer — Contract

System One; Columbia (MD); Hybride; USD 54 000 - 62 000; Plein temps

Résumé du poste

System One is seeking a contracted HEDIS Clinical Medical Review Nurse to conduct meticulous medical record reviews for NCQA-compliant projects in Columbia, MD. The role combines onsite and remote work in a hybrid arrangement and requires attention to detail across multiple EMR platforms.

The candidate will retrieve records, coordinate with provider offices, and support data collection efforts in the Quality Department. Training occurs at CareFirst’s Merriweather office in December 2026.

Qualifications

• Registered Health Information Associate/Registered Health Information Technician, Nursing, or a related clinical or healthcare field.
• Candidates qualifying in lieu of a degree must have 10 years of recent, relevant HEDIS medical record abstraction and/or overread experience within a payer, health insurance, or HEDIS vendor setting.
• 3 years of clinical experience and 5 years of HEDIS experience.
• RN or LPN with experience supporting HEDIS reporting and abstraction processes.
• Proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook) and web-based technology.
• Experience retrieving medical records from EMR platforms such as Epic, eClinicalWorks, Athena, Cerner, Allscripts, and Tebra.
• Ideal candidates reside in or near MD, DC, VA, PA, or DE.
• Will attend in-person training at CareFirst’s Merriweather office in December 2026.

Responsabilités

• Conduct thorough medical record reviews in accordance with NCQA specifications using proprietary tools and software.
• Retrieve and follow up on medical records, escalating issues as needed.
• Support EMR Medical Record Retrieval for HEDIS projects.
• Contact provider offices to request or validate facility and provider contact information and record retrieval preferences.
• Assist with other tasks within the Quality Department related to HEDIS data collection and abstraction.

Connaissances

HEDIS knowledge

Formation

Registered Health Information Associate/Registered Health Information Technician, Nursing, or related clinical/healthcare field

Outils

Epic

eClinicalWorks

Athena

Cerner

Allscripts

Tebra

Description du poste

System One is seeking a contracted HEDIS Clinical Medical Review Nurse to conduct meticulous medical record reviews for NCQA-compliant projects in Columbia, MD. The role combines onsite and remote work in a hybrid arrangement and requires attention to detail across multiple EMR platforms.

The candidate will retrieve records, coordinate with provider offices, and support data collection efforts in the Quality Department. Training occurs at CareFirst’s Merriweather office in December 2026.