REMOTE HEDIS RN (Contract) - 567832

HEDIS RN – Chart Review & Quality

Employment Type: Contract

Contract Duration: January – April

Focus: HEDIS | Chart Review | Clinical Data Abstraction | Healthcare Quality

Position Summary

We are seeking experienced RNs for a January–April contract opportunity supporting annual HEDIS and healthcare quality initiatives .

This is a detail-oriented, production-focused clinical role centered primarily on medical record review, clinical documentation, and data abstraction rather than direct patient care. The HEDIS Nurse will review electronic health records, claims information, provider documentation, laboratory results, medication records, and other clinical sources to identify evidence supporting applicable HEDIS measures and help close identified care gaps.

The ideal candidate has strong clinical knowledge, excellent attention to detail, and experience with HEDIS, quality measures, chart abstraction, managed care, population health, or medical record review .

Key Responsibilities

HEDIS Chart Review & Abstraction

• Conduct detailed medical record reviews to identify clinical information relevant to assigned HEDIS measures.
• Review physician notes, hospital records, laboratory results, medication records, claims, procedures, and other clinical documentation.
• Accurately abstract required clinical data according to current HEDIS technical specifications.
• Determine whether documentation meets numerator compliance requirements for applicable measures.
• Identify care gaps, missing documentation, and opportunities to improve quality performance.
• Enter and maintain clinical information accurately within designated HEDIS and quality management systems.
• Apply clinical judgment when interpreting diagnoses, procedures, medications, laboratory results, and treatment documentation.
• Ensure all abstracted information is supported by appropriate medical record documentation.

Quality & Compliance

• Follow current NCQA/HEDIS specifications and established chart abstraction guidelines.
• Maintain a high level of accuracy and consistency throughout chart reviews.
• Meet established productivity and quality expectations.
• Participate in quality assurance audits, calibration sessions, and remediation activities.
• Correct abstraction errors and incorporate feedback into future reviews.
• Maintain strict confidentiality and comply with HIPAA and applicable regulations.
• Stay current with changes to HEDIS measures, technical specifications, clinical guidelines, and quality reporting requirements.

Care Gap Identification

• Identify members with outstanding preventive care, chronic disease management, screening, and other quality gaps.
• Recognize documentation that supports closure of identified care gaps.
• Escalate questionable or incomplete documentation according to established workflows.
• Support quality improvement initiatives designed to improve member outcomes and HEDIS performance.

Collaboration

• Collaborate with Quality, Clinical Operations, Care Management, Provider Relations, Data Analytics, and other internal teams.
• Communicate effectively regarding chart review findings and documentation requirements.
• Participate in team meetings, training, calibration sessions, and ongoing education.
• Assist with special quality projects and other medical record review initiatives as assigned.

Required Qualifications

RN Candidates

• Current, unrestricted New York Registered Nurse (RN) license .
• Associate's degree in Nursing required; BSN preferred .
• HEDIS experience required.
• Minimum 2–3 years of clinical nursing experience .
• Experience reviewing and interpreting medical records.
• Strong understanding of medical terminology, diagnoses, medications, procedures, and clinical documentation.
• Strong computer skills and ability to navigate multiple electronic systems.
• Exceptional attention to detail and accuracy.
• Ability to work independently while meeting established productivity and quality deadlines.

Ideal Candidate

The ideal candidate is a clinically knowledgeable and highly organized nurse who enjoys chart review and quality-focused work . Experience with HEDIS, NCQA, medical record abstraction, managed care, population health, or quality improvement is highly valued.

This is an excellent short-term contract opportunity for an RN or LPN with HEDIS experience who is looking to support a high-impact healthcare quality initiative from January through April.