QM Nurse Abstractor

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking four (4) experienced QM Nurse Abstractors to support the 2027 HEDIS® audit. This remote/hybrid position may require occasional travel within the state of Connecticut. These temporary assignments will run from January 2027 through May 2027. MAJOR DUTIES AND RESPONSIBILITIES: Candidate will work with the HEDIS® team to conduct medical record abstraction reviews of records. Additionally, reviews require data analysis and research within data/claims systems, along with critical thinking skills as they will conduct research in a thoughtful and methodical search to locate specific claim information Candidate will be able to apply the technical specifications to records in electronic systems and written records. All results will be entered into the certified HEDIS® software platform. Candidates must work under the supervision of internal staff and designated lead to achieve goals and keep the project moving by adhering to measured productivity requirements. Module testing for HEDIS® specific measures may be required according to designated role. Candidate must pass a medical record abstraction test prior to starting actual record reviews. Must be flexible and willing to develop and share strategies to accomplish goals. Project is a timed study with tight deadlines that require high production/quality and staff committed to the entire season. REQUIRED EXPERIENCE AND KNOWLEDGE: Any combination of education and/or experience which would provide an equivalent background will be considered; Active and unrestricted Registered Nurse license required Requires a strong knowledge of HEDIS® technical specifications and NCQA health plan accreditation guidelines (minimum 1- 2 years). Excellent skill set for audit and abstraction of medical records Demonstrated knowledge and experience in managed care membership, provider, and/or hospital systems preferred. Candidates must have excellent computer skills and analysis capabilities, along with ability to log-on into multiple software as service tools. Knowledge of Microsoft office is required (proficient in Word, Excel, Outlook) Candidates must understand codes for services based on diagnosis and procedure based on HEDIS® Technical Specification requirements to support the overread process and validation of services as required. Must be research and detail oriented with the tenacity to find medical records and claim specific data for a specific measure within a given period. Requires effective written, oral, and interpersonal communication skills. Experience navigating Electronic Medical Records ( EMR) systems such as EPIC and similar platforms. Candidate should have a private workspace that complies with HIPAA requirements. Candidate must reside in Connecticut We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment. We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.