[Hiring] Quality Clinical Management Advisor @Cigna Healthcare

Role Description

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.

Key Responsibilities

• 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
• 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
• 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
• 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
• 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

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)
• Experience with 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

Salary and Benefits

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.

• Comprehensive health-related benefits including medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year and paid holidays