Clinical Nurse Specialist (RN) – Clinical Quality / HEDIS (Remote)

Location: Fully Remote (CST hours) Employment Type: Contract Positions Available: 1 Category: Healthcare

About the Role

A healthcare organization is seeking an experienced Clinical Nurse Specialist (RN) to support clinical quality operations, including HEDIS®, DSNP, and medical record review activities. This role is fully remote and requires strong attention to detail, technical proficiency, and the ability to work independently in a high‑production environment.

Work Schedule

• Monday–Friday, 8:00 AM–5:00 PM CST

• After-hours and weekend work may be required

• 1–2 weeks of training (limited time off during training)

Key Responsibilities

• Review and abstract medical records for HEDIS and HEDIS-like measures

• Perform data entry, data collection, and data mining

• Identify and highlight HEDIS/Star opportunities within medical documentation

• Track and report trends, barriers, and quality gaps

• Navigate multiple documentation systems to retrieve clinical data

• Request medical records from provider offices as needed

• Conduct inbound and outbound calls related to quality requirements

• Provide administrative and clerical support for quality initiatives

• Maintain HIPAA compliance and confidentiality

• Participate in team meetings and provide updates on clinical review findings

• Complete required HEDIS technical and software training

Required Qualifications

• Registered Nurse (RN)

• Minimum 2 years of HEDIS experience

• Experience with DSNP and clinical quality programs

• Strong medical record review and abstraction skills

• Knowledge of managed care quality requirements

• Excellent attention to detail and proofreading ability

• Strong communication and time‑management skills

• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Adobe)

• Ability to work independently and meet productivity standards

• Strong critical thinking and problem‑solving skills

Preferred Experience

• Background in:

  • HEDIS Operations

  • CAHPS

  • Accreditation

  • Quality improvement initiatives

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