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  1. Go to Settings.
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Jobs or company...

HEDIS Medical Review Nurse

  • Full Time, onsite
  • TalTeam
  • Remote HybridMay required to come onsite when required, United States of America
Salary undisclosed

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Dice

Availability Status

This job is expected to be in high demand and may close soon. We’ll remove this job ad once it's closed.

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Clinical Medical Review Nurse
Baltimore, MD _ Remote Role ( May required to come onsite when required )

ROLE: 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.

Experience: 3 years clinical experience, and 5 years HEDIS and Overread experience.

In Lieu of Education
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)

Preferred Qualifications
Bachelor's degree in Nursing, Associates Degree in Nursing, Diploma in Nursing
At least two consecutive HEDIS seasons with the same company.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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