About the job
Job Posting: Remote Registered Nurse (RN) – HEDIS
Department: Quality SDS Operations Schedule: Monday–Friday, 8:00 AM–5:00 PM CST Additional Hours: After-hours and weekend work may be required
Training: 1–2 weeks; limited time off during training period (details discussed during interview)
Position Overview: As a Remote RN, you will collaborate with the Quality SDS Operations staff to support DSNP data collection and contribute to various quality initiatives. This includes medical record review, data abstraction, and datamining to support HEDIS and HEDIS-like measures.
Key Responsibilities:
- Conduct market-specific data entry and collection
- Review and abstract medical records for HEDIS measures
- Assist in identifying Star/HEDIS opportunities for medical staff
- Monitor and close gaps in care through data review and entry
- Partner with leadership and clinical teams to identify trends and strategies
- Communicate challenges impacting quality outcomes
- Track barriers to care such as appointment access and coding inconsistencies
- Navigate multiple documentation systems to retrieve relevant records
- Request medical records from provider offices as needed
- Respond to inquiries via phone, fax, email, and internal systems
- Make in-bound and out-bound calls for quality-related tasks
- Provide administrative support for reporting and special projects
- Maintain up-to-date knowledge of HEDIS and STARs
- Attend conference calls and complete required training
- Ensure HIPAA compliance and confidentiality of health information
- Perform other duties as assigned
Required Qualifications:
- Active Registered Nurse license
- Minimum 2 years of HEDIS experience
- Strong understanding of managed care and clinical quality requirements
- Proficient in medical record review and abstraction
- Excellent research, proofreading, and detail orientation
- Strong time management and prioritization skills
- Effective communication and critical thinking abilities
- Proficiency in Microsoft Office (Word, Excel, Adobe, PowerPoint)
- Self-starter with a results-driven mindset
- Ability to work independently and maintain focus in a remote setting