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Sarah Jenkins
Remote Hedis Nurse jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the United States are expanding their quality improvement teams, creating strong demand for skilled professionals. With 500+ open positions available, employers are hiring for remote HEDIS nurse jobs that let nurses support measure compliance from anywhere in the country. Employers are actively seeking candidates who can balance clinical expertise with data-driven quality reporting.
The most sought-after HEDIS nurse vacancies call for strong knowledge of quality measures, chart abstraction, and medical record review processes. Successful candidates combine clinical nursing experience with analytical skills, attention to detail, and familiarity with quality improvement software and electronic health records. Strong communication abilities and time management are essential, since much of the work involves independent review and reporting within tight deadlines.
Remote HEDIS nurse positions have become increasingly common as health plans and provider networks adopt flexible staffing models to meet seasonal reporting deadlines. Nurses in this field typically work from home offices equipped with secure systems to access patient data, collaborating virtually with quality teams across different states. The growing emphasis on value-based care continues to fuel demand for professionals ready to hire a HEDIS nurse quickly and efficiently.
If you are ready to advance your career in healthcare quality, now is the time to explore HEDIS nurse jobs in the USA. Global Work AI connects dedicated nurses with top employers seeking remote talent, making it easy to find the right fit. Take the next step and discover new opportunities that match your skills and career goals today.
Murtech
Conduct comprehensive medical record reviews to evaluate clinical documentation and compliance with standards. Analyze clinical information to support HEDIS and quality improvement initiatives. Identify discrepancies in medical documentation and coding accuracy.
remote, PA, United StatesFull TimeMiddle (2-4 years)Murtech
Conduct comprehensive medical record reviews to evaluate clinical documentation and compliance with standards. Analyze clinical information to support HEDIS and quality improvement initiatives. Identify discrepancies in medical documentation and coding accuracy.
remote, PA, United StatesFull TimeMiddle (2-4 years)Health Center Partners of Southern California
Lead clinical performance improvement initiatives, support implementation of evidence-based practices, and analyze quality and operational performance. Collaborate with health center executives and clinical leaders to drive quality improvement strategies and improve patient outcomes.
remote, CA, United States$98k – $119k/yrFull TimeLead / Manager
Cinqcare
Design and implement a comprehensive clinical training program for Provider staff, including Nurse Practitioners and Physician Assistants. Oversee training content development, ensure compliance with regulatory standards, and monitor performance to improve patient care outcomes.
remote, Washington, DC, United States$130k – $150k/yrFull TimeLead / Manager
Intermountain Health
Review medical records for HEDIS audits, abstracting relevant clinical information using a proprietary tool. Perform remote medical record reviews, ensuring compliance with HEDIS, CMS, and STARS measures.
remote, UT, United States$71k – $107k/yrPart TimeMiddle (2-4 years)
Horizon Blue Cross Blue Shield of New Jersey
Conduct member assessments to evaluate clinical, functional, and psychosocial needs. Develop and implement individualized care plans while coordinating services with healthcare providers. Monitor member outcomes and ensure adherence to care management guidelines and quality standards.
remote, CT, United States$63k – $84k/yrFull TimeMiddle (2-4 years)
company
Act as a quality improvement liaison with physician offices and community agencies to promote care management. Identify members with gaps in care, assess needs, and make referrals to clinical programs.
remote, Albany, NY, United States$45k – $76k/yrFull TimeLead / Manager
Wellbe Senior Medical
Lead the execution of the Quality program across Part C and Part D, managing the Quality team and establishing productivity standards. Redesign care-gap closure workflows for efficiency and scalability, and partner with various stakeholders to enhance HEDIS and Medicare Advantage Stars performance.
remote, United StatesFull TimeDirector
Humana
Oversee a team to establish policies for provider engagement, guide strategies for quality measures, and develop outreach campaigns. Monitor team performance against KPIs and contractual commitments, ensuring alignment with corporate partners.
remote, IL, United States$115k – $158k/yrFull TimeDirector
Centene Corporation
Collaborate with providers to improve HEDIS measures and educate on coding. Conduct telephonic outreach and face-to-face education with members regarding care gaps. Schedule doctor appointments and arrange transportation for members.
remote, IA, United States$54k – $98k/yrFull TimeJunior (<2 years)
Guidehealth
Lead initiatives to improve HEDIS medication adherence and pharmacy quality measures. Analyze medication adherence data, identify care gaps, and implement interventions. Conduct medication therapy management sessions and collaborate with healthcare providers to promote adherence.
remote, United States$120k – $130k/yrFull TimeJunior (<2 years)
Amerihealth Caritas
Produce quality and performance reports, interpret claims data, and analyze utilization trends. Attend meetings with providers to address care gaps and develop action plans. Implement performance-related projects and collaborate with peers to enhance provider performance.
remote, Newark, DE, United StatesFull TimeMiddle (2-4 years)Amerihealth Caritas
Produce quality and performance reports, interpret claims data, and analyze utilization trends. Attend meetings with providers to address care gaps and develop action plans. Implement performance-related projects and collaborate with peers to enhance provider partnerships.
remote, LA, United StatesFull TimeMiddle (2-4 years)
Lifepoint Health
Track and analyze clinical quality measures and governmental requirements for ACO/CIN initiatives. Educate providers on documentation and coding techniques for accurate risk profiles. Oversee strategic initiatives related to primary care workflow improvements and post-acute care.
remote, United StatesFull TimeJunior (<2 years)
Medical Mutual
Coordinates and collaborates interdepartmentally to produce the annual HEDIS Roadmap, including data documentation and reconciliation. Reviews data sources for accuracy and compliance with HEDIS specifications.
remote, OH, United StatesFull TimeLead / Manager
Advantmed
Conduct data collection and abstraction of medical records for HEDIS projects. Review medical records and transfer critical HEDIS data elements into a data entry portal. Maintain accuracy thresholds and comply with HIPAA regulations. Attend required training sessions within a defined timeframe.
remote, United States$40k – $54k/yrPart TimeJunior (<2 years)
WellSense Health Plan
Perform medical record abstraction and data entry for HEDIS and regulatory audits. Ensure accuracy and compliance of medical records across various EMR systems. Collaborate with internal teams and provider offices to procure and review medical records, supporting quality performance goals.
remote, United States$62k – $89k/yrFull TimeJunior (<2 years)Amerihealth Caritas
Develop and manage the annual HEDIS project plan, ensuring compliance with NCQA and regulatory reporting. Support HEDIS audits and facilitate relationships with Medical Record Review vendors. Ensure data accuracy for HEDIS software and lead enhancements to HEDIS analytics offerings.
remote, United StatesFull TimeLead / ManagerAlliance
Analyze clinical workflows for optimization, develop and maintain process documentation, and ensure system configurations align with workflows. Lead HEDIS lifecycle support, analyze healthcare data for trends, and provide recommendations for improvement.
remote, NC, United States$91k – $116k/yrFull TimeSenior (5+ years)Centene Corporation
Educate providers on HEDIS measures, medical record documentation, and coding. Collect and analyze provider performance data to identify improvement opportunities. Collaborate with Provider Relations to enhance quality and operational performance.
remote, MI, United States$54k – $98k/yrFull TimeJunior (<2 years)Advantmed
Learn and apply HEDIS concepts based on Technical Specifications and client guidance. Complete training on HEDIS measures, including recorded demos and assessments. Provide knowledge transfer to abstractors during their training phase and live season.
remote, United States$50k – $60k/yrPart TimeJunior (<2 years)Horizon Blue Cross Blue Shield of New Jersey
Conduct assessments of members' clinical, functional, and psychosocial needs. Develop and implement individualized care plans while coordinating services with healthcare providers. Monitor member outcomes and ensure adherence to care management guidelines and quality standards.
remote, CT, United States$63k – $84k/yrFull TimeMiddle (2-4 years)Horizon Blue Cross Blue Shield of New Jersey
Conduct assessments of members' clinical, functional, and psychosocial needs. Develop and implement individualized care plans while coordinating services with healthcare providers. Monitor member outcomes and ensure adherence to care management guidelines and quality standards.
remote, CT, United States$63k – $84k/yrFull TimeMiddle (2-4 years)
Montage Health
Lead enterprise STAR strategy to achieve and sustain 4+ STAR ratings. Oversee HEDIS, HOS, and administrative measure performance. Drive cross-functional initiatives to improve clinical outcomes and member satisfaction.
remote, United States$150k – $210k/yrFull TimeDirectorCentene Corporation
Maintain partnerships with provider networks, ensuring high-quality care delivery. Act as the primary contact for providers, resolving issues and managing network performance. Educate providers on policies, perform orientations, and drive performance improvements in quality and cost utilization.
remote, GA, United States$56k – $101k/yrFull TimeJunior (<2 years)Humana
Lead cross-functional quality improvement initiatives to enhance clinical quality and provider performance. Analyze healthcare data to identify improvement opportunities and implement targeted interventions.
remote, SC, United States$78k – $108k/yrFull TimeSenior (5+ years)
Network Health WI
Develop and implement intervention plans to improve quality ratings and reduce medical costs. Conduct HEDIS and medical record reviews, ensuring compliance with OCI, CMS, and NCQA standards. Collaborate with providers and members to close quality gaps and coordinate care management programs.
remote, WI, United StatesFull TimeMiddle (2-4 years)
Monogram Health
Lead the in-home multi-specialty polychronic care model, overseeing clinical and business operations. Review and approve care plans from advanced practice providers, nurses, and pharmacists. Ensure adherence to clinical guidelines and improve patient outcomes through evidence-based pathways.
remote, PA, United States$260k – $340k/yrFull TimeJunior (<2 years)Centene Corporation
Analyze and monitor clinical quality improvement activities, ensuring compliance with customer expectations. Lead Behavioral Health Performance Improvement Projects (PIPs) and review clinical information for appeals to determine medical necessity.
remote, United States$68k/yrFull TimeJunior (<2 years)
Health Services Advisory Group, Inc.
Lead HEDIS compliance audits and performance measure validation activities. Evaluate information systems, data integrity, and measure calculation processes. Conduct primary source verification and record-level testing, and prepare audit workpapers and client-facing reports.
remote, United States$100k – $130k/yrFull TimeSenior (5+ years)
Medica
Conduct medical record reviews and clinical quality audits to ensure compliance with quality standards. Collect and validate clinical documentation, prepare audit findings, and support quality programs through data abstraction.
remote, AR, United States$70k – $105k/yrFull TimeSenior (5+ years)
Alignment Health
Develop and execute clinical strategies for value-based care, focusing on patient management across the continuum of care. Oversee clinical program lifecycle, establish KPIs, and ensure alignment with regulatory requirements.
remote, United States$228k – $342k/yrFull TimeVP / C-level
Waymark
Own HEDIS quality measures and operationalize quality programs. Design workflows, manage vendor partners, and coordinate implementation of quality initiatives. Conduct analyses to identify execution issues and collaborate with teams to develop training and job aids.
remote, CA, United States$127k – $157k/yrFull TimeSenior (5+ years)Health Services Advisory Group, Inc.
Provide leadership and operational oversight for Medicaid Services audit projects, including PMV and HEDIS activities. Manage project planning, implementation, and performance monitoring, ensuring deliverables are accurate and submitted on time.
remote, United States$133k – $160k/yrFull TimeDirector
Firely
Manage ONC/ASTP certification maintenance, including preparing and submitting quarterly packages and filing SVAP submissions. Conduct Real World Testing and NCQA HEDIS measure certification, ensuring compliance and communication with NCQA.
remote, United States$90k – $110k/yrFull TimeMiddle (2-4 years)
Molina Healthcare
Provide senior clinical support to the quality team, ensuring timely and accurate quality of care investigations. Conduct audits of medical records and monitor key quality activities involving clinical decision-making.
remote, United StatesFull TimeSenior (5+ years)
Florida Blue (Blue Cross and Blue Shield of Florida)
Lead the development of a unified quality operating model across Medicare and Commercial lines. Oversee HEDIS operations, accreditation strategy, and clinical quality programs. Manage vendor ecosystems for HEDIS data collection and ensure compliance with NCQA and URAC standards.
remote, FL, United StatesFull TimeVP / C-levelMolina Healthcare
Manage quality data collection strategies, analytics, and reporting to improve health outcomes. Oversee quality-related projects, ensuring compliance with regulatory guidelines and maximizing HEDIS audit success.
remote, Long Beach, CA, United StatesFull TimeMiddle (2-4 years)
Together Women's Health, LLC
Lead MIPS reporting and quality improvement initiatives, ensuring compliance with CMS requirements. Oversee performance tracking for quality programs like HEDIS and Stars, and manage data analytics for quality metrics.
remote, Grosse Pointe, MI, United StatesFull TimeLead / ManagerMolina Healthcare
Oversee and implement health plan quality improvement activities to ensure compliance with state, federal, and NCQA regulations. Manage quality program activities, prepare reports, and monitor deliverables.
remote, MI, United StatesFull TimeLead / Manager10,000,000+ more jobs available!
