Clinical Medical Review Nurse – HEDIS Retrospective Project

About the role

Company Description: Lumen Solutions Group Inc. is a technology consulting services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

Position: Clinical Medical Review Nurse - HEDIS Retrospective Project. Locations: Columbia, MD. Work Arrangement: Primarily Remote | Occasional Provider-Site Visits. Provider visits are not frequent—historically, there have been only a few site visits during the project. Candidates will be selected for provider-site visits based largely on their proximity to the applicable provider location.

Position Overview: We are seeking experienced Clinical Medical Review Nurses to support a HEDIS Retrospective Review Project. This role will focus on medical record retrieval, clinical record abstraction, HEDIS/quality measure review, pain management-related reviews, and potentially conducting overreads. The position is primarily remote, with occasional onsite provider visits.

Responsibilities

• Perform HEDIS retrospective medical record review and abstraction.
• Review medical records to identify and validate information required for applicable HEDIS and quality measures.
• Conduct clinical/medical record review, including pain management-related reviews.
• Potentially perform overreads/quality validation reviews.
• Conduct regular outreach to provider offices to obtain required medical records.
• Request and retrieve medical records through phone, email, fax, provider portals.
• Communicate professionally with provider offices regarding medical record requests and follow-ups.
• Ensure accurate and timely abstraction of clinical information.
• Apply HEDIS and quality-measure guidelines when reviewing medical records.
• Support quality assurance activities and additional project requirements as assigned.

Qualifications

• 3+ years of clinical experience.
• 5+ years of recent/current HEDIS experience, or an equivalent combination demonstrating strong clinical and HEDIS expertise.
• Strong hands-on experience with HEDIS and healthcare quality programs.
• Demonstrated ability to review medical records and identify information relevant to HEDIS/quality measures.
• Current/recent experience performing medical record retrieval and abstraction.
• Comfortable communicating with provider offices and requesting records through phone, email, fax, and provider portals.
• Strong understanding of HEDIS measures and medical record documentation.
• Active applicable clinical license is preferred/required based on the candidate's clinical background and licensing situation.
• Ability to successfully complete a potential HEDIS knowledge assessment.
• Education: Bachelor's degree is preferred. Candidates without a Bachelor's degree may be considered with 10+ years of relevant HEDIS experience.