HEDIS Clinical Medical Review Specialist

Location: Hybrid in Columbia, Maryland, with reporting to the client office during the first training week and provider offices in the Maryland area 1–2 times per month.

Company

hirify.global provides a six-month contract assignment supporting a healthcare client’s HEDIS operations.

What you will do

• Contact provider offices to request or validate facility and provider contact information and document outreach.
• Retrieve medical records through EMR systems and upload received charts to the abstraction platform.
• Review and abstract clinical data according to HEDIS measures, NCQA specifications, and company training guidelines.
• Create and research clinical and retrieval pends using software applications supporting HEDIS operations.
• Escalate retrieval issues and support additional medical record retrieval needs within the Quality Department.

Requirements

• Active CNA, RN, or LPN license required; DC, Maryland, or Virginia licensure is preferred, while licenses from all states and NLC licensure are accepted.
• Bachelor’s or associate degree in Nursing is highly preferred, with five years of HEDIS experience and three years of clinical experience; ten years of relevant experience is required without a degree.
• Experience in medical case management, discharge planning, or utilization review, with current knowledge of clinical practices and medical policies.
• Recent HEDIS abstraction or overread experience on the payer or health insurance side, or with a HEDIS vendor, is required.
• Expertise with an EMR system is required; Epic, eClinical, or Cerner experience is an advantage.
• Strong communication, customer service, and Microsoft Office skills.

Culture & Benefits

• Six-month contract assignment.
• Hybrid work arrangement with initial in-person training.
• Work supporting HEDIS quality operations and medical record retrieval.
• Start date: November 30, 2026, required for training purposes.