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.