HEDIS Clinical Medical Review Nurse
N/A, OFFSITE
Experience: 0
Category: Healthcare
Contractor Work Model: Hybrid
Brand: ALTA IT Services
Job ID: 342024
Date Posted: 10/07/2025
Shortcut: http://jobs.systemone.com/p26NrK
Job Title: Clinical Medical Review Nurse
Location: Maryland, Virginia and D.C.
Type: Contract
Compensation: $41.50
Contractor Work Model: Hybrid
The Clinical HEDIS Nurse (Medical Review Specialist) is responsible for supporting the organization’s HEDIS and Quality initiatives through medical record retrieval, clinical data abstraction, and quality review processes in alignment with NCQA specifications. This role demands significant expertise in HEDIS measures, EMR navigation, and clinical abstraction. The nurse must maintain strict adherence to HIPAA Privacy and Security standards and demonstrate a strong commitment to data accuracy, quality improvement, and timely execution.
Candidates must hold an active RN or LPN license.
This is a hybrid role, with a combination of remote work and potential on-site requirements based on operational needs.
- Contact provider offices to request or validate facility and provider contact information specifically for HEDIS medical record retrieval.
- Retrieve and upload medical records from electronic medical record (EMR) systems in accordance with HIPAA requirements and HEDIS guidelines.
- Abstract clinical data from medical charts accurately and efficiently using proprietary abstraction platforms and following company-specific training and NCQA specifications.
- Use internal systems to create, track, and research clinical and retrieval pends to support overall HEDIS operations.
- Document all communications, record retrieval activities, and chart status updates in designated systems.
- Assist with outreach and coordination efforts to maximize medical record collection efficiency and compliance.
Overreading:
- Review and validate abstracted charts completed by other team members for accuracy and adherence to HEDIS guidelines.
- Correct errors identified during overread and conduct additional chart reviews when similar errors are found.
- Collaborate with abstractors to provide feedback and re-education when necessary.
- Support medical record retrieval activities for risk adjustment, supplemental data validation (PSV), and various other quality and HEDIS-related initiatives outside of the core season.
Education:
- Degree in Nursing (Associate’s, Diploma, or Bachelor’s)
- Credentials such as RHIA, RHIT, or a related field preferred
- Active RN or LPN license is required
- At least 3 years of clinical nursing experience
- Minimum of 5 years of HEDIS experience in a health plan or vendor setting
- Strong understanding of NCQA quality metrics
- Experience with HEDIS abstraction software or tools (e.g., Reveleer, Cotiviti, Inovalon) preferred
- Proficiency in Microsoft Office applications (Excel, Word, PowerPoint, Outlook, Teams)
- Experience with multiple EMR systems, including Epic, eClinicalWorks, Athena, Cerner, AllScripts, and Tebra
- Strong attention to detail and analytical thinking
- High degree of accuracy in data interpretation and entry
- Excellent time management and organizational skills
- Ability to work independently and collaboratively in a fast-paced environment
- Professional communication skills, both written and verbal
- Hybrid work model (remote and occasional in-office work as needed)
- Requires prolonged periods of sitting and working on a computer
- Frequent phone interaction with provider offices may be required
System One, and its subsidiaries including Joulé, ALTA IT Services, and 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.
#M2
#LI-AJ1
#DI-
Ref: #850-Rockville (ALTA IT)
-
Quality Compliance Associate
East Windsor, NJ
Job Title: Quality Compliance Associate Location: East Windsor, New Jersey Type: Contract Compensation: $26 - $36 per hour Contractor Work Model: Onsite Hours: 8/9 AM – 5/6 PM, Monday to Friday Industry: Pharmaceuticals, Sterile Injectable Products Res...
Date Posted: 12/04/2025 Recommended
-
Regulatory Analyst /Food Science
Hershey, PA
Job Title: Regulatory Analyst / Food Science Location: Hershey, PA Type: Contract 12 months Contractor Work Model: Hybrid Job Description: Regulatory Analyst would be responsible for reviewing basic regulatory information to ensure accuracy between lab...
Date Posted: 11/05/2025 Recommended
-
QC Analytical Supervisor
Allendale, NJ
Job Title: QC Analytical Supervisor Location: Northern NJ (Commutable from Rockland, Bergen, Essex, Morris) Type: Contract-to-Hire Hours: 2nd shift, 2:30 PM – 11:00 PM Pay Rate: $50–$58 per hour (Depending upon experience) Be part of a growing, innovat...
Date Posted: 10/21/2025 Recommended
-
Quality Control Inspector
Exton, PA
Job Title: Quality Control Inspector Location: Exton, PA Type: Contract to hire Schedule: Monday-Friday 8am-5pm Pay Rate: $30/hour Overview: Growing Pharmaceutical Company is seeking an experience Quality Control Inspector to join their team on a contr...
Date Posted: 11/26/2025 Recommended
-
Ingredient Compliance Specialist
Parsippany, New Jersey
Job Title: Ingredient Compliance Specialist Type: Direct Hire Location: Morris County, NJ (Whippany/Parsippany, NJ) Schedule: Hybrid | 9:00 a.m.–5:00 p.m. Salary: $70,000–$85,000 + performance bonus About the Opportunity We are seeking an Ingredient Co...
Date Posted: 11/20/2025 Recommended
-
Chief Financial Officer
Jersey City, New Jersey
Job Title: Chief Financial Officer Location: Jersey City, New Jersey Type: Direct Hire Compensation: $160000 - $180000 annually Contractor Work Model: Onsite Requirements: • CPA required (must be transferable to New Jersey). • MBA or equivalent advance...
Date Posted: 11/12/2025 Recommended
-
OMICS Laboratory Research Technician IV
Pittsburgh, PA
Title: OMICS Laboratory Research Technician IV Location: Onsite, Pittsburgh, PA 15219 Type: 6-month contract to hire Hours: 8AM-5PM Start: December Overview: Join a vital institutional core research team to support biological research by using techniqu...
Date Posted: 11/17/2025 Recommended
-
OMICS Laboratory Lead/Manager II
Pittsburgh, PA
Title: OMICS Laboratory Manager II Location: Onsite, Pittsburgh, PA 15219 Type: 6-month contract to hire Hours: 8AM-5PM Start: December Overview: Join as a Laboratory Manager II to monitor personnel and workflow in the area. Track and monitor QA/QC in ...
Date Posted: 12/03/2025 Recommended
-
Certified Medical Assistant
Frisco, Texas
Job Title: Certified Medical Assistant (CMA), Neurology Location: Frisco, TX | Onsite Hours/Schedule: Monday–Friday, rotating Saturday shifts required Type: Direct Hire Overview A leading neurology clinic in the DFW area is seeking a Certified Medical ...
Date Posted: 10/09/2025 Recommended
-
Clinical Supplies Associate
Basking Ridge, NJ
Title: Clinical Supplies Associate Location: Basking Ridge, NJ (Hybrid; onsite 2 days per week) Type: 12 Month Contract Schedule: M-F Day Pay: $30-34/hour Responsibilities: Monitor and assess temperature data for clinical trial shipments and on-site st...
Date Posted: 10/17/2025 Recommended
-
Revenue Cycle Specialist / Biller and Coder
Frisco, Texas
Job Title: Revenue Cycle Specialist Location: Frisco & Carrollton, Texas (Onsite) Hours/Schedule: Full-time, Monday–Friday Type: Direct Hire Overview A growing neurology practice with multiple locations in the Frisco and Carrollton areas is seeking an ...
Date Posted: 10/08/2025 Recommended
-
Catacel Production Operator
Savannah, Georgia
Job Title: Catacel Production Operator Location: Savannah, Georgia Type: Contract Compensation: $20/Hour Contractor Work Model: Onsite Hours: 6-2:30pm Responsibilities Perform coating and assembly operations following standard operating procedures (SOP...
Date Posted: 10/10/2025 Recommended
-
Clinical Research Coordinator - Euless
Dallas, TX
Job Title: Clinical Research Coordinator Location: Euless, TX 76040 Type: Contract To Hire Contractor Work Model: Onsite Elevate your career in clinical research! Joule, in partnership with a leading client, is recruiting for a crucial, full-time Clini...
Date Posted: 11/20/2025 Recommended
-
OMICS Laboratory Manager I
Pittsburgh, PA
Title: OMICS Laboratory Manager I Location: Onsite, Pittsburgh, PA 15219 Type: 6-month contract to hire Hours: 8AM-5PM Start: December Overview: Join as a Laboratory Manager I to manage day-to-day laboratory operations while ensuring compliance with sa...
Date Posted: 11/26/2025 Recommended
-
Quality Laboratory Manager
Freehold, New Jersey
Job Title: Quality Laboratory Manager Location: Freehold, NJ Type: Direct Hire Compensation: $80000 - $90000 annually Contractor Work Model: Onsite Hours: Monday-Thursday 8 am till 5 pm & Fridays 8 am till 2 pm Quality Laboratory Manager Key Responsibi...
Date Posted: 11/17/2025 Recommended
-
Temporary Senior Corporate Counsel, Contracts Attorney
Alameda, CA
Job Title: Senior Corporate Counsel, Contracts Attorney Location: Alameda, CA (100% Onsite – Remote candidates will not be considered) Hours/Schedule: Contract Compensation: $115–$135/hour doe Type: Contract Overview A leading biotechnology company loc...
Date Posted: 11/04/2025 Recommended
-
Research Coordinator
Boston, MA
Title: Drug Clinical Research Coordinator Location: Boston MA Schedule: M-F (onsite daily) 8-5 Duration: 6 month contract to hire Pay Rate: $25-$30/hr Start: ASAP Education: Bachelor’s Degree Requirements: 1-3 years of relevant experience in human clin...
Date Posted: 11/18/2025 Recommended
-
Registered Nurse – Clinical Oversight & Staff Supervisor
Frisco, Texas
Job Title: Registered Nurse – Clinical Oversight & Staff Supervisor Location: Frisco, Texas Type: Direct Hire/Permanent Contractor Work Model: Onsite Hours: Monday - Thursday, 8:00am - 5:00pm, Friday 8:00am - Noon Joule is partnering with a well-respec...
Date Posted: 10/14/2025 Recommended
-
Mass Spectrometry Senior Scientist
Pittsburgh, PA
Title: Mass Spectrometry Senior Scientist Location: Onsite, Pittsburgh, PA 15232 Type: 6-month contract to hire Hours: 8AM-5PM Start: December Overview: Join in establishing a state-of-the-art, multi-omics facility to support research and clinical tran...
Date Posted: 11/25/2025 Recommended
-
Pharma Technical Writer
New Brunswick, NJ
Job Title: Pharma Technical Writer Location: New Brunswick, NJ Hours/Schedule: Mon-Friday (normal business hours) Compensation: $34.87- $44.29 Type: Contract Overview Leading pharmaceutical company looking for an experienced Technical Writer. Ideal can...
Date Posted: 10/14/2025 Recommended
-
HR Administrative Assistant
Portage, MI
Job Title: HR Administrative Assistant Location: Portage, MI Hours/Schedule: 8:00am to 5:00pm Type: Contract Requirements 1+ year experience in an administrative position, with experience preferred in worker’s compensation, leaves of absence administra...
Date Posted: 12/05/2025 Recommended
-
Plant Instrument and Controls Tech/Instrument Engineer
West Deptford, New Jersey
Job Title: Plant Instrument and Controls Tech/Instrument Engineer Location: West Deptford, New Jersey Type: Contract Compensation: $30 - $35 hourly Contractor Work Model: Onsite Responsibilities: - A key member of our Team supporting industrial instrum...
Date Posted: 09/29/2025 Recommended
-
Quality Laboratory Technician
Bethlehem, PA
Title: Quality Laboratory Technician Location: Bethlehem, PA Type: Contract to Hire Start: Immediate Overview: This position is responsible for the day-to-day activities involved in QC analytical testing within a quality control microbiological laborat...
Date Posted: 12/02/2025 Recommended
-
Systems Engineer - Backup and Storage
Rockville, MD
Job Title: Systems Engineer Location: Rockville, MD Shift/Schedule: Standard business hours, Monday–Friday (2 days onsite per week). Some flexibility depending on patching/maintenance needs. On-call for emergencies and occasional weekend work for criti...
Date Posted: 11/14/2025 Recommended
-
Scientist II
Alameda, CA
Job Title: Scientist II Location: Alameda, CA Type: Contract Compensation: $55-$60 an hour W2 Contractor Work Model: Onsite MUST HAVE: Experience analyzing PK samples and experience with WinNonlin. SUMMARY/JOB PURPOSE: The Scientist II will be joining ...
Date Posted: 11/26/2025 Recommended
-
Analytical Chemist II
Richmond, VA
Job Title: Analytical Chemist II Location: Richmond, VA Type: Contract Job Description: The Senior Scientist role will be responsible for assessing, developing, and validating analytical methods for Dietary Supplements and Over the Counter Products to ...
Date Posted: 11/20/2025 Recommended
-
Building Engineer/HVACR Apprentice
Golden Valley, MN
Job Title: Building Engineer / HVACR Apprentice Location: Minneapolis, MN Type: Contract Contractor Work Model: Onsite Hours: Flexible; Monday–Friday. *Minimum 20 hours/week during the school year and 40 hours/week when school is out of session* Overvi...
Date Posted: 11/20/2025 Recommended
-
Laboratory Technician
Flanders, New Jersey
Job Title: Laboratory Technician Location: Flanders, New Jersey Type: Contract Compensation: $21/hr Contractor Work Model: Onsite Hours: 7 to 3, or 7:30 to 3:30 M-F Responsibilities Evaluate product properties using established test methods Perform app...
Date Posted: 12/01/2025 Recommended
-
Metrology Technician
West Point, Pennsylvania
Job Title: Metrology Technician Location: West Point, Pennsylvania Type: Full-time Compensation: $30 - $35 hourly Work Model: Onsite Responsibilities: Provides comprehensive, compliant technical services and support for miscellaneous instrumentation an...
Date Posted: 11/18/2025 Recommended
-
LCMS Research Technician IV
Pittsburgh, PA
Title: LCMS Research Technician IV Location: Onsite, Pittsburgh, PA 15219 Type: 6-month contract to hire Hours: 8AM-5PM Start: Jan Overview: Join a cutting-edge research team driving innovation at the intersection of genomics, proteomics, and transcrip...
Date Posted: 12/04/2025 Recommended