Clinical Medical Review Nurse

Work Location & Schedule:
•    The role will be primarily remote, with the flexibility to work from home.
•    Candidates must be willing to travel to provider offices to collect medical records. Most locations will be within Maryland (MD) and Washington, DC, with occasional travel to Northern Virginia.
•    Mileage reimbursement will be provided when multiple provider locations need to be visited in a single day. If travel is required to only one location, the schedule may be considered hybrid.
•    Candidates must also be comfortable commuting to the Merriweather office in Columbia, MD, for team meetings and other job-related activities.

Required Qualifications & Experience:
1.    Nursing / Clinical Credentials:
o    Active RN or LPN license from the DMV region or a compact nursing license.
o    CNA candidates with 10+ years of HEDIS experience may also be considered.
o    A BS or AS degree in Nursing is preferred. Candidates without either degree must have at least 10 years of HEDIS experience.
2.    HEDIS Experience:
o    Minimum of 5+ years of recent, hands-on HEDIS experience.
o    Strong experience with HEDIS medical record extraction, retrospective reviews, and quality reviews.
o    Overread/audit review experience is highly preferred.
3.    Clinical & Medical Records Experience:
o    Minimum of 3+ years of solid clinical experience.
o    Strong understanding of clinical reviews, medical terminology, and medical documentation.
o    Hands-on medical records review experience is required.
4.    EMR / Technical Skills:
o    Hands-on experience with EMR systems is required.
o    Experience with Epic, eClinicalWorks, or Cerner is highly preferred.
o    Strong computer skills and proficiency in Microsoft Office applications, particularly Word, Excel, and Teams.
5.    Additional Responsibilities:
o    The role will involve both inbound and outbound calls with provider offices to coordinate medical record requests and related activities.
Key Soft Skills:
•    Strong organizational and time-management skills.
•    Excellent attention to detail.
•    Effective verbal and written communication.
•    Ability to work collaboratively as part of a team.