RN-Quality Clinical Management Advisor

Job Summary

Leads clinical quality measurement and improvement activities, ensuring successful execution of Healthcare Effectiveness Data and Information Set (HEDIS®) while advancing the transition to digital quality measurement (dQM). Accountable for market performance, regulatory compliance, vendor management, and the modernization of data acquisition, measurement, and reporting capabilities.

Scope & Impact

• Primary market lead for end-to-end HEDIS execution and performance outcomes

• Drives measurable improvement in quality metrics and Stars/HEDIS performance

• Leads adoption of digital quality measurement capabilities, including EHR-enabled data capture and interoperability

• Influences cross-functional teams (clinical, IT, provider, vendor, customer facing, and enterprise stakeholders)

• Manages vendors, budget, and operational efficiency for quality programs

Key Responsibilities

1. HEDIS/QRS Market Leadership

• Direct annual HEDIS production, submission, and audit readiness

• Own market-level performance strategy, identifying and closing care gaps

• Lead state-specific submissions and regulatory requirements

• Serve as SME on HEDIS specifications, abstraction, clinical data acquisition, and reporting

2. Digital Quality Measurement (dQM) Transformation

• Lead transition from hybrid/manual to digital quality measurement

• Partner with IT and vendors to enhance clinical data acquisition (EHR, HIE, FHIR-enabled sources)

• Modernize workflows, clinical data acquisition, and reporting

3. Data & Analytics Enablement

• Translate performance data into actionable insights for clinical and operational teams

• Identify automation and process optimization opportunities to reduce manual effort and cost

4. Vendor & Project Management

• Manage vendor relationships, deliverables, and performance

• Oversee contractor resources and ensure accountability to timelines and outcomes

• Manage budget and drive operational efficiencies

• Lead cross-market and national initiatives

5. Stakeholder & Matrix Leadership

• Partner with Market Medical Executives, Provider Experience, Contracting, IT, Legal, and Clinical teams

• Support client-facing engagements and performance discussions

• Represent organization in external quality collaborations and initiatives

Required Qualifications

• Bachelor's degree; Registered Nurse (RN) required

• 3-5 years HEDIS measurement and reporting experience

• 5+ years clinical quality/performance improvement experience

• Strong knowledge of NCQA, and regulatory requirements

• Experience in managed care or healthcare delivery environment

• Demonstrated project management, analytical, and communication skills

Preferred Qualifications

• Master's degree (Nursing, Public Health, Informatics, or related field)

• Experience with digital quality measurement and data modernization initiatives

• Proficiency with EHR Systems and MS Excel

• Knowledge of clinical data standards and interoperability (e.g., FHIR, HL7), and Tableau, PowerBI, and healthcare interoperability solutions

• Vendor management experience

Core Competencies

• Quality Measurement Expertise (HEDIS, gap closure, audit readiness)

• Digital & Data Acumen (EHR data, interoperability, automation)

• Strategic & Analytical Thinking (insight generation, ROI focus)

• Matrix Leadership & Influence (cross-functional alignment)

• Operational Execution (timelines, budget, vendor performance)

Success Measures

• On-time, accurate HEDIS/QRS submission and strong audit outcomes

• Improvement in key quality metrics and market performance rankings

• Increased digital data capture and reduced reliance on manual abstraction

• Demonstrated operational efficiencies and cost savings

• Strong stakeholder and client satisfaction

Work Conditions

• Travel: <10%

• Work Arrangement: Remote

*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 89,200 - 148,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here (https://jobs.thecignagroup.com/us/en/benefits) .

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.