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
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About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
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.
If you need a reasonable accommodation to complete the online application process, please email
[email protected]
for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner
consistent with all federal, state and local ordinances.