Medical Review Nurse

We are seeking a Medical Review Nurse to support claims review, HEDIS abstraction, and quality analysis activities within a healthcare environment.Requirements:Active RN or LPN License (MD or Compact License)5+ years of clinical experienceStrong experience with EMR systemsBasic proficiency in Excel and Microsoft OfficeResponsibilities:Review and analyze medical records for claims adjudication and HEDIS measuresPerform medical record abstraction and data extractionSupport pre- and post-claim medical reviewsAssist with medical policy interpretation and risk assessmentParticipate in training sessions and occasional provider site visitsPreferred:HEDIS experience (not mandatory – training provided)Experience in utilization review, case management, or discharge planningKey Notes:Must reside in MarylandHybrid schedule with occasional travel to provider officesPanel interview (single round)Strong attention to detail, clinical judgment, and ability to work in a fast-paced environment are essential.