HEDIS Medical Review Nurse (RN or LPN)

At nTech Workforce, we specialize in providing comprehensive staffing and recruiting solutions tailored to meet the unique needs of our clients. Our approach is rooted in understanding industry dynamics and leveraging our extensive network to connect top-tier talent with leading organizations. We emphasize quality placements through rigorous testing and personalized recruitment strategies, ensuring both client satisfaction and candidate success. Our commitment extends beyond mere staffing; we foster long-term partnerships by continuously adapting to industry trends and client requirements. By prioritizing candidate training and professional development, we empower individuals to excel in their roles and contribute effectively to organizational growth.

Role: HEDIS Medical Review Nurse W2 Contract: 6 Months Location: Remote Primarily remote with candidates being required to reside in MD, DC, PA, VA, or DE. There will be a 3-day training period onsite in Canton, MD - MUST Infrequent travel required to onsite provider offices Full-Time, M-F, 8:00 am to 5:00 pm Pay Rate: $39/hour on W2 - All inclusive Overview & Key Responsibilities: Our client is seeking a HEDIS Medical Review Nurse to play a vital role in their annual Healthcare Effectiveness Data and Information Set (HEDIS) project. This is a critical seasonal assignment that directly impacts healthcare quality scores and regulatory compliance. The ideal candidate is a highly organized and clinically knowledgeable professional with extensive HEDIS abstraction experience. The role involves the thorough review and abstraction of medical records, close collaboration with provider offices, and utilization of advanced technology skills to ensure data accuracy and quality measure compliance. This is an excellent opportunity for an experienced nurse to leverage their clinical knowledge and critical thinking skills in a fast-paced, team-focused environment.

Conduct thorough medical record reviews to collect and validate data against HEDIS performance measures. Abstract relevant clinical data from electronic and paper medical records and accurately enter findings into HEDIS electronic database software. Retrieve medical records via Electronic Medical Record (EMR) systems or fax requests, ensuring strict compliance with HIPAA and member confidentiality requirements. Travel to provider offices in the DMV area (DC, Maryland, Virginia) as needed to retrieve medical records, and potentially travel between multiple offices in one day. Perform outreach to provider offices, primarily outbound phone calls, to request records, validate facility/provider addresses, and clarify documentation discrepancies, with the expectation of receiving call-backs. Utilize extensive knowledge of HEDIS measures to facilitate medical record abstraction for gap closure and additional data gathering. Document all outreach and follow-up efforts and maintain established daily productivity and accuracy levels. Collaborate with the Quality Improvement team to identify trends in abstraction and resolve documentation issues, providing feedback to abstractors as needed. Maintain a flexible approach to problem-solving and be able to quickly adapt to changing priorities and processes during the HEDIS season.