Remote HEDIS Nurse Consultant

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 for other accommodation options.

Workplace Type: This is a fully remote position. Application Deadline: This position is anticipated to close on Jan 7, 2026.

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