Remote HEDIS Review Nurse

Shape Healthcare Quality from Anywhere

Are you an experienced nurse with a strong background in medical record review and performance improvement? Do you have an analytical mindset and a passion for quality metrics? This is your opportunity to contribute meaningfully as a Remote HEDIS Review Nurse, where your expertise will drive impactful decisions in preventive care tracking, documentation auditing, and reporting excellence—all while working from the comfort of your home. Offering an annual salary of $71,500, this role invites you to become part of a high-performing team using data, technology, and innovation to improve health outcomes.

Key Purpose of the Role

As a HEDIS Review Nurse, you will focus on capturing precise healthcare metrics across multiple data sources to ensure accurate reporting on quality indicators. You’ll support annual HEDIS initiatives by reviewing patient charts, identifying gaps in care, and verifying compliance with NCQA standards. Your work will directly influence performance evaluations, healthcare reimbursements, and preventive care strategy.

What You’ll Do Every Day

Comprehensive Medical Record Analysis

• Extract, assess, and abstract medical records using clinical judgement aligned with HEDIS technical specifications
• Perform clinical validation of ICD-10, CPT, and HCPCS codes related to care compliance
• Identify preventive care and chronic condition gaps using evidence-based criteria

Collaborative Data Review Processes

• Collaborate remotely with care managers, coders, analysts, and providers to verify medical data accuracy
• Participate in quality assurance audits to uphold chart abstraction standards
• Submit documented findings into advanced HEDIS reporting platforms

Project Management & Compliance

• Track project milestones and meet data collection deadlines for HEDIS cycles
• Stay updated on annual HEDIS specification changes and integrate updates into workflows
• Support regulatory and accreditation compliance through careful data reporting

Performance Enhancement Support

• Contribute to process improvement by providing insights from abstraction trends
• Offer actionable feedback for provider education around documentation standards
• Assist in developing strategies for improving care gap closure and member engagement

Tools and Technologies You'll Use

You will be equipped with cutting-edge tools that streamline review and data abstraction:

• Electronic Health Record Systems (EHR): Epic, Cerner, Allscripts
• HEDIS Software Platforms: Inovalon, Cotiviti, and Medisolv
• Cloud Collaboration Tools: Microsoft Teams, SharePoint, and Zoom
• Project Management Suites: Jira, Trello, and Asana
• Secure Document Transfer: HIPAA-compliant file sharing platforms

This position emphasizes fluency in navigating health informatics tools, chart review applications, and data validation software, enabling you to work effectively in remote clinical data environments.

Work Environment & Culture

As part of a digitally forward healthcare team, you’ll thrive in a fully remote, yet collaborative environment that values precision and autonomy. Communication channels are structured yet dynamic, enabling seamless virtual cooperation with compliance teams, providers, and analytics personnel. You’ll experience a balance of independent focus and collaborative insight-sharing, promoting both personal growth and collective success.

This role provides consistent schedules with seasonal peak periods aligned to the HEDIS calendar. During those windows, workflow intensifies with measurable deliverables, giving a clear sense of purpose and achievement. Outside of HEDIS season, the focus pivots to continuous quality improvement and performance optimization.

Success Metrics & Impact

Your work contributes directly to:

• Accurate HEDIS Compliance Ratings: Boosting the organization’s quality scores
• Improved Preventive Care Engagement: Ensuring more members complete essential screenings
• Optimized Reimbursement Rates: Enabling precise reporting tied to performance-based payments
• Data-Driven Healthcare Decisions: Informing strategy with clinically validated insights

Ideal Candidate Profile

Required Qualifications

• Active, unrestricted RN license (multi-state compact preferred)
• Minimum 3 years of clinical experience, including 1+ year in HEDIS abstraction or quality review
• Deep understanding of HEDIS and NCQA requirements
• High proficiency with EHR navigation, remote abstraction platforms, and Microsoft Excel

Preferred Expertise

• Certification in Healthcare Quality (e.g., CPHQ) is a plus
• Familiarity with risk adjustment models and STARS ratings
• Exposure to managed care, ACOs, or population health settings
• Experience working with cloud-based project tools in a virtual team

Skills That Set You Apart

• Detail-oriented mindset with strong analytical skills
• Ability to manage high volumes of data without compromising accuracy
• Excellent verbal and written communication skills
• Self-discipline and motivation to perform independently in a remote setting
• Adaptability to evolving guidelines and tech systems

Career Growth and Learning

As healthcare evolves toward value-based care, this role places you at the intersection of data intelligence and clinical integrity. You'll have access to continuing education programs, emerging analytics tools, and leadership mentoring. Growth paths include roles in quality program management, clinical analytics, or population health strategy.

Why Join Us?

Competitive Benefits

• Annual salary of $71,500
• Generous PTO and paid holidays
• Remote work allowance and ergonomic setup support
• Health, dental, vision, and wellness incentives
• Opportunities for certification reimbursement and upskilling

A Culture of Innovation

• Emphasis on innovation, agility, and digital-first healthcare operations
• Regular knowledge-sharing sessions with analytics and tech teams
• Encouragement of ideas that refine process, data, and outcomes

Tech-Inspired Call to Action

Ready to play a vital role in healthcare transformation—while working remotely with advanced tools and forward-thinking peers? Join us in shaping quality benchmarks and building healthier communities through precision-driven care metrics.

Take the next step in your nursing journey—apply today and become a key player in remote healthcare excellence!