What are the responsibilities and job description for the Medical Review Nurse position at Reczu?
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 experience
- Strong experience with EMR systems
- Basic proficiency in Excel and Microsoft Office
Responsibilities:
- Review and analyze medical records for claims adjudication and HEDIS measures
- Perform medical record abstraction and data extraction
- Support pre- and post-claim medical reviews
- Assist with medical policy interpretation and risk assessment
- Participate in training sessions and occasional provider site visits
Preferred:
- HEDIS experience (not mandatory – training provided)
- Experience in utilization review, case management, or discharge planning
Key Notes:
- Must reside in Maryland
- Hybrid schedule with occasional travel to provider offices
- Panel interview (single round)
- Strong attention to detail, clinical judgment, and ability to work in a fast-paced environment are essential.