QM Nurse Abstractor

Community Health Network of Connecticut, Inc. • Wallingford, CT

3d • $0 - $45 • Hybrid

About The Position

Community Health Network of Connecticut, Inc. (CHNCT) is seeking four experienced QM Nurse Abstractors to support the 2027 HEDIS® audit. This temporary remote/hybrid position may require occasional travel within Connecticut and runs from January 2027 through May 2027. Candidates must reside in Connecticut and have a private workspace that complies with HIPAA requirements.

The Nurse Abstractor works with the HEDIS® team to review and abstract medical records, research data and claims systems, and enter results into certified HEDIS® software. The role requires applying technical specifications to electronic and written records, meeting measured productivity and quality requirements under the supervision of internal staff and a designated lead, and potentially performing HEDIS® measure module testing. Candidates must pass a medical record abstraction test before beginning record reviews and commit to the full season of this timed project with tight deadlines.

Requirements

• Active and unrestricted Registered Nurse license.
• At least 1–2 years of strong knowledge of HEDIS® technical specifications and NCQA health plan accreditation guidelines.
• Excellent medical record audit and abstraction skills.
• Excellent computer skills and analytical capabilities, including the ability to log on to multiple software-as-a-service tools.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Knowledge of service codes based on diagnosis and procedure in accordance with HEDIS® Technical Specification requirements.
• Research- and detail-oriented, with the persistence to locate medical records and measure-specific claims data within a given period.
• Effective written, oral, and interpersonal communication skills.
• Experience navigating electronic medical record systems such as EPIC or similar platforms.
• Must reside in Connecticut.
• Must have a private workspace that complies with HIPAA requirements.
• Must pass a medical record abstraction test before beginning actual record reviews.
• Must be flexible and committed to the full project season.

Nice To Haves

• Demonstrated knowledge and experience in managed care membership, provider, and/or hospital systems.
• Equivalent background through any combination of education and/or experience will be considered.

Responsibilities

• Conduct medical record abstraction reviews with the HEDIS® team.
• Analyze and research data and claims systems to locate specific claim information.
• Apply HEDIS® technical specifications to electronic and written records.
• Enter results into the certified HEDIS® software platform.
• Work under the supervision of internal staff and a designated lead to meet project goals, productivity requirements, and deadlines.
• Perform module testing for HEDIS® specific measures if required by the designated role.
• Develop and share strategies to accomplish project goals.
• Support the overread process and validation of services by understanding diagnosis- and procedure-based codes according to HEDIS® Technical Specification requirements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed