Remote HEDIS Nurse Consultant

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Remote HEDIS Nurse Consultant

Description

HEDIS work typically includes requesting records, abstracting/overreading medical records, performing claims research, preparing medical records for the NCQA HEDIS Auditor, etc.

Abstracts medical record data from practitioner’s files to support annual Healthcare Effectiveness Data and Information Set (HEDIS) reporting for company's accredited products

Conducts medical record reviews to support the annual reporting and responds to inquiries from provider, and their office staff, regarding the HEDIS initiative

Review and abstract 40-50 medical records per day, based on NCQA and HEDIS technical specifications

Document information clearly and concisely from patient record to paper document abstraction tool, or into company's electronic HEDIS application

Ensure Health & Care Management are in compliance with HEDIS audit and technical specification standards

Participate in the training of NCQA (national committee quality assurance) requirements with completion of Inter-Rater Reliability compliance

Communicate with internal and external stakeholders by making appropriate follow-up phone calls for additional medical information to complete reviews

Comply with regulatory standards, accreditation standards and internal guidelines

Remain current and consistent with the standards pertinent to the Quality Management team

Qualifications

• Active and Unrestricted RN License with 4 years of experience.
  
  

(Need to have the license in the state in which they live but does not need to be compact since they are not working directly with members in Iowa.)

• Strong clinical background and understanding of medical terminology, healthcare practices and electronic medical record systems. Ability to review medical records and technical specifications and draw defensible conclusions from available information.
• Experience In health insurance, health care, managed care, or a related setting. A strong clinical background could also be considered – e.g., hospital medical records or research.
• Excellent attention to detail and ability to analyze complex medical records, identify relevant data and abstract HEDIS measures accurately.
• Strong written and verbal communication skills with ability to communicate and/or present complex information to team members and stakeholders.
• Demonstrated success in roles that require strong time management and work-flow management skills. Ability to prioritize work independently, manage multiple assignments simultaneously, and meet deadlines.
• Flexibility to adapt to changing requirements, regulations, and technology platforms related to HEDIS reporting.
• Proficiency with Microsoft Office and Microsoft Teams. Technical aptitude to learn new systems quickly.
  
  

Preferred Qualifications

• 2 years of experience in HEDIS abstraction and familiarity with HEDIS measure specifications.
• Prior work in utilization management, quality management/review, accreditation, outpatient clinic setting or related area.
  
  

Job Type & Location

This is a Contract position based out of Des Moines, IA.

Pay and Benefits

The pay range for this position is $40.00 - $41.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
  
  

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Jan 7, 2026.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com ( actalentaccommodation@actalentservices.com) for other accommodation options.

If you have questions about this posting, please contact support@lensa.com