HEDIS RN

Job Title: HEDIS Registered Nurse (RN) Job Description The HEDIS Registered Nurse (RN) plays a key role in quality improvement by performing comprehensive medical record reviews, abstracting clinical data, and validating documentation for HEDIS (Healthcare Effectiveness Data and Information Set) measures. This position works closely with healthcare providers, quality teams, and health plan stakeholders to improve member outcomes, close care gaps, and ensure accurate HEDIS reporting in alignment with NCQA standards. Responsibilities Review and abstract clinical information from electronic medical records (EMRs) to support HEDIS measures and broader quality improvement initiatives. Analyze member medical records to identify care gaps and opportunities for clinical intervention. Validate medical record documentation to ensure compliance with HEDIS and NCQA guidelines and standards. Conduct clinical over-reads and quality audits to maintain data accuracy and reporting integrity. Collaborate with providers, care teams, and internal departments to obtain missing documentation and improve quality scores. Support chart retrieval and medical record collection efforts through remote EMR access and proactive provider outreach. Monitor productivity and accuracy standards while maintaining strict confidentiality and HIPAA compliance. Assist with quality improvement projects, audits, and performance improvement initiatives as assigned. Document findings and maintain detailed, organized records within designated systems and databases. Participate in team meetings, training sessions, and ongoing quality improvement activities to stay current with best practices and evolving guidelines. Essential Skills Active, unrestricted Registered Nurse (RN) license. Associate's degree in Nursing or equivalent nursing education. Experience reviewing clinical documentation and medical records. Strong understanding of medical terminology, disease processes, and healthcare documentation. Proficiency with electronic medical records (EMRs). Proficiency with Microsoft Office applications. Exceptional attention to detail and strong organizational skills. Knowledge of HEDIS methodologies and quality reporting standards. Strong analytical and critical thinking skills. Ability to interpret clinical documentation accurately. Effective written and verbal communication skills. Ability to manage multiple priorities in a fast-paced environment. Comfortable working independently while meeting productivity and quality metrics. Strong commitment to data accuracy, regulatory compliance, and patient confidentiality. Additional Skills & Qualifications Previous experience in HEDIS, quality improvement, utilization review, case management, or medical record abstraction. Familiarity with NCQA and HEDIS quality measures. Experience working with Medicare, Medicaid, or managed care populations. Bachelor's degree in Nursing (BSN). Prior remote chart abstraction experience. Professional experience within healthcare, medical settings, or managed care environments. Work Environment This role offers a remote work opportunity depending on business needs, with standard Monday through Friday business hours and occasional overtime during peak HEDIS season. The position operates within a collaborative team environment that is focused on improving healthcare quality and member outcomes, leveraging electronic medical record systems and common office productivity tools to support accurate data collection and reporting. Job Type & Location This is a Contract position based out of Saint Louis, MO. Pay and Benefits The pay range for this position is $32.00 - $40.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. 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 Sep 14, 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 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service. 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 process due to a disability, please email [email protected] for other accommodation options. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.