Job Description
Title: HEDIS Nurse Reviewer (Several Openings)
Location: Fully Remote – Must Reside in North Carolina
Pay: $30–$40 per hour, based on licensure and experience
Schedule: Monday–Friday, 8:00 AM–5:00 PM EST; No Overtime
Employment Type: W2 Assignment – 7 months, with potential for extension or conversion to FTE based on business needs
About the role
We are seeking multiple licensed RNs or LPNs to support a healthcare quality team with medical record retrieval and data collection in preparation for HEDIS season. This role involves contacting provider offices, obtaining medical records, documenting outreach and follow-up, and accurately uploading records into the appropriate database. The position is primarily computer-based and includes a high volume of daily provider communication and detailed documentation.
Responsibilities
- Contact provider offices by phone and fax to request medical records
- Handle approximately 40–50 inbound and outbound calls and faxes per day
- Follow up on outstanding medical record requests until records are obtained
- Work with HEDIS Operations and Risk Adjustment teams to collect and organize member records
- Accurately document research, outreach, contact information, and follow-up activity
- Review and label medical records using established naming conventions
- Upload medical records into the appropriate abstraction database
- Maintain accurate and organized records while managing a high volume of requests
Qualifications
- Associate Degree in Nursing required; Bachelor’s degree preferred but not required
- Active RN or LPN license required; state or compact licensure accepted
- Minimum 4 years of nursing experience required
- At least 1 year of experience in medical record review, quality improvement, clinical administrative work, call center work, or a related area
- Experience working with medical record systems or electronic documentation
- Strong computer skills, including Excel proficiency
- Ability to manage a high-volume workload while maintaining accurate documentation
- Strong organizational skills and attention to detail
- Professional communication and follow-up skills when working with provider offices
- Ability to commit to the full-time schedule throughout the assignment
Training and interview requirements
Training is a required two-week course held Monday–Friday, 8:00 AM–5:00 PM EST. Candidates should disclose any planned time off on their resume and during the interview.
The interview will be conducted through Microsoft Teams. Candidates must participate on camera using a laptop or desktop computer. A computer skills assessment will be included as part of the interview process, and an Excel literacy test is required before candidate submission.
Important requirements
Candidates must have an active, non-expired RN or LPN license and experience working with electronic medical records or documentation. Strong computer skills are essential, including the ability to navigate Excel and successfully complete required computer testing. Candidates must also be able to manage a high volume of calls and faxes while maintaining accurate documentation and professional communication with provider offices.
Assignment details
This is a 7-month W2 assignment supporting annual HEDIS preparation activities. The team brings contractors on ahead of the official HEDIS season to assist with medical record collection, documentation, and data preparation. Extension or conversion to a permanent position may be possible based on business needs but is not guaranteed.