QM Nurse Abstractor

Community Health Network of Connecticut • Wallingford, CT

3d • Hybrid

About The Position

Community Health Network of Connecticut, Inc. is seeking four experienced QM Nurse Abstractors to support the 2027 HEDIS® audit. This remote/hybrid temporary assignment runs from January 2027 through May 2027 and may require occasional travel within Connecticut. 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, conduct data analysis and research in data and claims systems, and apply technical specifications to records in electronic systems and written records. Results are entered into a certified HEDIS® software platform. The work is supervised by internal staff and a designated lead, and requires meeting productivity and quality goals throughout a timed project with tight deadlines. Module testing for specific HEDIS® measures may be required, depending on the assigned role. Candidates must pass a medical record abstraction test before beginning record reviews.

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 in to multiple software-as-a-service tools.
• Proficiency in Microsoft Word, Excel, and Outlook.
• Understanding of service codes based on diagnoses and procedures in accordance with HEDIS® Technical Specification requirements.
• Research- and detail-oriented approach, with the tenacity to locate medical records and claim-specific data for a given measure and period.
• Effective written, oral, and interpersonal communication skills.
• Experience navigating electronic medical record systems, such as EPIC or similar platforms.
• Residence in Connecticut.
• A private workspace that complies with HIPAA requirements.
• Ability to pass a medical record abstraction test before starting record reviews.
• Flexibility and willingness to develop and share strategies, and commitment to the entire audit season.

Nice To Haves

• Demonstrated knowledge and experience in managed care membership, provider, and/or hospital systems.
• Equivalent combinations of education and/or experience that provide an appropriate background will be considered.

Responsibilities

• Conduct medical record abstraction reviews for the HEDIS® audit.
• Analyze data 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.
• Conduct module testing for HEDIS® measures when required by the designated role.
• Develop and share strategies to accomplish project goals.
• Support the overread process and validation of services as required.

What This Job Offers

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