RN-Quality Clinical Management Advisor
About The Position
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. This role is the primary market lead for end-to-end HEDIS execution and performance outcomes, driving measurable improvement in quality metrics and Stars/HEDIS performance. It also leads the adoption of digital quality measurement capabilities, including EHR-enabled data capture and interoperability, influences cross-functional teams, and manages vendors, budget, and operational efficiency for quality programs.
Requirements
- 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
Nice To Haves
- 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
Responsibilities
- 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
- 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
- Translate performance data into actionable insights for clinical and operational teams
- Identify automation and process optimization opportunities to reduce manual effort and cost
- 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
- 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
Benefits
- Medical
- Vision
- Dental
- 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
- Paid holidays
- Annual bonus plan
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
