Nurse, Clinical Medical Reviewer

Position : Nurse, Clinical Medical Review

Location : Baltimore, MD #HYBRID

Duration : 6months #C2H

Rate : $35 / hr

Position is primarily remote but will be required to attend a three-four day in-person training at Client's Canton location as well as travel to local Provider offices for onsite Medical Record retrieval as needed.

Job Description :

• The Clinical Medical Review Specialist (a professional with clinical experience) will report to the Clinical Support Supervisor HEDIS and be part of the Quality Team.
• The main duties include chart retrieval, using proprietary tools and software to conduct thorough medical record reviews in line with NCQA specifications, retrieval follow-up, and escalating issues as needed.
• Main duties will be assigned according to experience, knowledge, skills, and abilities.
• This role requires extensive knowledge of HEDIS measures to accurately and expediently abstract medical records, all while adhering to HIPAA Privacy and Security standards.
• Additional tasks involve helping with EMR Medical Record Retrieval for HEDIS, contacting provider offices to request or validate facility and provider contact information and record retrieval preference, and / or requesting medical records for the HEDIS project and supporting other needs within the Quality Department.

ESSENTIAL FUNCTIONS :

10% Call provider offices to request or validate facility / provider contact information specifically for HEDIS medical record retrieval. Document all outreach efforts.

20% Retrieve medical records via EMR that meet HEDIS requirements and ensure compliance with HIPAA. Upload charts to abstraction platform upon receipt.

40% Use extensive knowledge of HEDIS measures to facilitate accurate and efficient data abstraction from charts within the abstraction platform on a daily basis according to HEDIS specifications and company training guidelines.

20% Use various software applications to support HEDIS operations by creating and researching clinical and retrieval pends

10% Other duties as assigned (see 'additional functions' below)

Additional functions assigned according to experience, knowledge, skills, and abilities :

Overreading (may replace the abstraction function) :

Risk Adjustment :

Required Skills :

QUALIFICATIONS :

Thanks & Regards,

LAXMAN

Team Lead - Talent Acquisition

KMM Technologies, Inc.