RN-Quality Clinical Management Advisor
The job profile for this position is Quality Clinical Management Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. 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. 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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.