Clinical Quality RN

Job Posting : Clinical Quality RN – HEDIS

Schedule : Monday–Friday, 8 AM–5 PM CST (After-hours and weekend work may be required) Training : 1–2 weeks (Limited time off during training; details discussed during interview)

Location : Remote

About The Role

HEDIS Operations brings together skilled professionals from across the quality spectrum, including HEDIS, CAHPS, and Accreditation. Our mission is to deliver exceptional performance that exceeds the expectations of our stakeholders, customers, and members. As a Clinical Quality RN, you will support the Quality SDS Operations team in collecting DSNP data and improving care outcomes through detailed medical record review and abstraction.

Key Responsibilities

• Conduct market-specific data entry and collection
• Review and abstract medical records for HEDIS and HEDIS-like measures
• Perform datamining to identify quality improvement opportunities
• Highlight Star / HEDIS gaps for clinical teams
• Collaborate with leadership and clinical staff to identify trends and strategies
• Navigate multiple documentation systems to retrieve relevant records
• Request and manage medical records from provider offices
• Respond to inquiries via phone, fax, TruCare, and email
• Make in-bound and out-bound calls for quality-related tasks
• Provide clerical and administrative support for reporting and special projects
• Maintain current knowledge of HEDIS / STARs requirements
• Attend conference calls and complete required HEDIS training and testing
• Ensure HIPAA compliance and confidentiality of health information

Required Qualifications

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