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 Responsibilities1. 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, .
