Job Title: Registered Nurse (HEDIS)
Location: Baltimore, MD (Hybrid)
Duration:6-12+ Months Contract
PURPOSE:
The Clinical Medical Review Nurse (an RN with clinical experience) will report to the Clinical Support Supervisor – HEDIS and be part of the Quality Team. The main duties include conducting thorough HEDIS overreads in line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating in internal audits for Supplemental Data, and supporting other needs within the Quality Department.
Qualifications
Experience: 3 years clinical experience, and 5 years HEDIS and Overread experience.
10 years of recent HEDIS abstractions / overreads experience in the payer/health insurance side of HEDIS or with a HEDIS vendor (ex. Cotiviti, Inovalon, Reveleer)
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