RN-Quality Clinical Management Advisor

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.

• 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.

• 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.

• 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 (FHIR, HL7) and tools such as Tableau and Power
  
  BI.
• Vendor management experience.

• 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).

• 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.

Travel: