The Cigna Group
Healthcare
RN-QualityClinicalManagementAdvisor
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“RN-Quality Clinical Management Advisor at The Cigna Group. Skills: HEDIS execution, Digital quality measurement, Clinical data acquisition, Performance improvement. Direct annual HEDIS production. Ensure submission and audit readiness”
What You'll Achieve.
Successful execution of HEDIS; Advancing transition to digital quality measurement; Accountable for market performance; Accountable for regulatory compliance; Accountable for vendor management; Accountable for modernization of data acquisition; Accountable for modernization of measurement; Accountable for modernization of reporting capabilities; Drives measurable improvement in quality metrics; Drives measurable improvement in Stars/HEDIS performance; Leads adoption of digital quality measurement capabilities; On-time HEDIS/QRS submission; Accurate HEDIS/QRS submission; Audit outcomes; Improvement in key quality metrics; Improvement in market performance rankings; Increased digital data capture; Reduced reliance on manual abstraction; Demonstrated operational efficiencies; Cost savings; Stakeholder satisfaction; Client satisfaction
Industry & Context.
Analytical skills; Insight generation
<10% travel
What They're Looking For.
Must Have
Bachelor’s Registered Nurse (RN) required, 3–5 years HEDIS measurement and reporting experience, 5+ years clinical quality/performance improvement experience, knowledge of NCQA, knowledge of regulatory requirements, Experience in managed care or healthcare delivery environment, Demonstrated project management skills, Demonstrated analytical skills, Demonstrated communication skills
Nice to Have
Master’s degree preferred, Experience with digital quality measurement, Experience with data modernization initiatives, Vendor management experience
What You'll Do.
Direct annual HEDIS production
Ensure submission and audit readiness
Own market-level performance strategy
Lead state-specific submissions
Meet regulatory requirements
Serve as SME on HEDIS specifications
Serve as SME on abstraction
Serve as SME on clinical data acquisition
Serve as SME on reporting
Lead transition to digital quality measurement
Partner with IT and vendors
Enhance clinical data acquisition
Modernize clinical data acquisition
Translate performance data into insights
Identify automation opportunities
Identify process optimization opportunities
Manage vendor relationships
Manage vendor deliverables
Manage vendor performance
Oversee contractor resources
Ensure accountability to timelines
Ensure accountability to outcomes
Drive operational efficiencies
Lead cross-market initiatives
Lead national initiatives
Partner with Market Medical Executives
Partner with Provider Experience
Partner with Contracting
Partner with Clinical teams
Support client-facing engagements
Support performance discussions
Represent organization in external quality collaborations
Represent organization in external quality initiatives
How You'll Work.
Team & Collaboration
Cross-functional teams; Clinical teams; IT teams; Provider teams; Vendor teams; Customer facing teams; Enterprise stakeholders; Market Medical Executives; Provider Experience; Contracting; Legal; External quality collaborations
Communication Scope
Communication skills
Process & Methodology
Project management, Vendor management
Full Job Description
**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
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