Remote HEDIS Abstractor – Registered Nurse

HEDIS Nurse RN (Remote – candidates residing in PST or MST time zone states only)

Contract/Seasonal (January – end of April)
Pay Rate: $45/hr
Schedule: Monday–Friday, 8:00 AM – 5:00 PM PST during training (first 4 weeks); flexible 8–5 schedule in your time zone afterward
Start Date: January

Position Summary

We are seeking experienced HEDIS Registered Nurses to support health plan quality initiatives through medical record review and data abstraction. In this role, you’ll be responsible for reviewing electronic medical records (EMRs), abstracting key clinical data, and validating quality performance metrics used for HEDIS reporting. The ideal candidate will bring hands-on experience in medical record abstraction and a strong understanding of NCQA and HEDIS quality measures.

Key Responsibilities

• Conduct detailed medical record reviews and EMR abstractions for HEDIS quality reporting.
• Identify and coordinate clinical audits to uncover areas for quality improvement.
• Collect and organize data using standardized HEDIS methodologies and abstraction tools.
• Audit outpatient, hospital, clinical lab, and pharmacy records for accuracy and compliance.
• Complete quality monitoring and chart abstraction audits, ensuring data integrity and consistency.
• Investigate gaps in care and verify documentation to support exclusions or numerator compliance.
• Collaborate with cross-functional quality and clinical teams to close care gaps and enhance performance outcomes.
• Ensure compliance with NCQA, CMS, and organizational quality standards.

Required Qualifications

• Active, unrestricted RN license (any state).
• Minimum 2 years of HEDIS experience performing medical record abstraction.
• Experience accessing and abstracting data from multiple EMR systems.
• Strong attention to detail and accuracy in data validation.
• Familiarity with NCQA HEDIS specifications and quality reporting standards.
• Excellent communication and documentation skills.

Preferred Skills

• Prior experience in quality improvement, utilization management, or health plan operations.
• Proficiency with abstraction platforms and data entry tools (e.g., Cotiviti, QSHR, Reveleer).
• Ability to work independently in a remote environment with minimal supervision.\

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Job Types: Full-time, Contract

Pay: $45.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Work Location: Remote