Clinical Medical Review Specialist

Please, no agencies or recruiters, only W2 applicants.

Vega Consulting is staffing a Utilization Review Specialist for our direct Healthcare client.  Primarily remote, with the exception of candidates will be required to attend Training the week of December 14th and occasionally travel to provider sites. This is a 6-month+ contract, hybrid role. Candidates license for Maryland, VA or Wash DC. (RN or LPN).

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.

Candidates job Requirement:

• 3 years acute clinical experience, previous case management, discharge planning or utilization review experience
• Maryland BCBA license OR Virginia BCBA license OR Washington DC BCBA license
• RN/LPN state licensing or compact
• Ambulatory Practice
• Candidate must be willing to travel to provider locations to retrieve medical records
• Remote EMR Access
• Education Level: Bachelor's Degree
• Remote EMR access is essential as well as ambulatory practice experience
• 5 years Clinical nursing experience
• 2 years Care Management
• Education Details: Nursing
• Ability to effectively communicate and provide positive customer service to every internal and external customer, Proficient
• Strong interpersonal skills. Ability to work independently, as well as a member of a team , Advanced
• Current knowledge of clinical practices and related medical policies., Proficient
• Strong organizational skills, ability to prioritize responsibilities with attention to detail., Proficient
• Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and web-based technology., Proficient
• Must possess excellent verbal and written communication skills. , Advanced

If you are a RN or LPN seeking a hybrid based position, select "Apply Now" and a Vega Staffing Specialist will reach out to you.