HEDIS Clinical Medical Review Nurse

Job Title: HEDIS Clinical Medical Review Nurse
Location: Hybrid – primarily remote (Columbia, MD)
Contract: 5-Month Contract (W-2)
Compensation: $41/hour

Overview
We are seeking a HEDIS Clinical Medical Review Nurse with strong experience in HEDIS medical record abstraction, chart review, and quality reporting within a health plan, payer, or HEDIS vendor environment. The ideal candidate will be an RN or LPN with 5+ years of HEDIS experience and 3+ years of clinical experience, proficient in reviewing medical records against NCQA specifications and working with EMR systems such as Epic, Cerner, Athena, eClinicalWorks, or Allscripts. Candidates should be local to the DMV area (MD/DC/VA) and comfortable working in a primarily remote environment with occasional onsite attendance for training and provider-site visits as needed.

Responsibilities

• Conduct thorough medical record reviews in accordance with NCQA specifications using proprietary tools and software.
• Retrieve and follow up on medical records, escalating issues as needed.
• Support EMR Medical Record Retrieval for HEDIS projects.
• Contact provider offices to request or validate facility and provider contact information and record retrieval preferences.
• Assist with other tasks within the Quality Department related to HEDIS data collection and abstraction.

Requirements

• RN or LPN (RHIA, RHIT) or a related clinical/healthcare background with strong HEDIS experience
• 5+ years of HEDIS medical record abstraction, chart review, and/or overread experience
• 3+ years of clinical nursing experience
• Experience working within a health plan, payer, health insurance, or HEDIS vendor environment
• Candidates without a degree must have 10+ years of recent HEDIS abstraction and/or overread experience
• Familiarity with NCQA HEDIS measures and quality reporting processes
• Experience using EMR platforms such as Epic, Cerner, Athena, eClinicalWorks, Allscripts, or Tebra
• Proficiency with Microsoft Office and web-based applications
• Local to the DMV area (MD/DC/VA preferred)
• Ability to attend required onsite training at CareFirst's Merriweather office in Columbia, MD (December 2026) and occasional provider-site visits as needed

System One, and its subsidiaries including Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

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Ref: #851-Rockville-S1