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RN Quality Clinical Management Lead Analyst - Work from Home - EST or CST Time Zones

Job typeFull Time
CountryUnited States
Role Summary: The purpose of this position is to support the Quality Management program by driving continuous quality improvement activities through execution of Healthcare Effectiveness Data and Information Set (HEDIS®)*/Quality Rating System (QRS) hybrid medical record data collection and related activities, as well as support and engage in Clinical Initiatives and Transparency activities, as assigned.

Major Duties:
  • Manages clinical measurement and quality improvement market activities for Commercial and Individual Family Plan customers
  • Identify, develop, and implement HEDIS/QRS data collection and process improvement initiatives to assure that Cigna demonstrates market leading results and meets customer and client HEDIS/QRS performance guarantees
  • Leads completion of annual HEDIS/QRS quality measurement and reporting requirements to regulatory and/or accrediting bodies
  • Serves as a Project Lead by managing HEDIS temporary staff, individuals assigned to the project, or other quality management project activities as assigned
  • Engages Provider offices and vendors to successfully complete project within organizational timeframes
  • Serves as an active and engaged Market Lead on HEDIS/QRS and quality-related project teams to improve workflows, continually driving operational efficiency and excellence
  • Develop, revise, and document policies, job aides, standard operating procedures, and workflows
  • Assist Clinical Measurement and Improvement team in delivering necessary program documents, operations, and improvements for relevant accreditation, transparency, community collaboratives, and HEDIS/QRS reporting requirements
  • Engage CAC provider groups and related internal and external matrix partners

  • Bachelor's degree with RN. Master's degree, or relevant Healthcare experience
  • Minimum five years of quality management/quality improvement/performance improvement experience
  • Five years clinical health care and HEDIS/QRS hybrid medical record review training preferred
  • Managed care and/or other healthcare service delivery experience preferred
  • Excellent time management, project management, organizational, research, analytical, negotiation, communication, and interpersonal skills
  • Ability to work in a fast paced environment, to multi-task, be nimble, and identify key work priorities
  • Travel estimate less than 5%
  • Proficiency in Microsoft Office products (e.g., Word, Excel, PowerPoint, Access, WebEx, SharePoint)

*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
Employer091 Cigna Health & Life Ins. Co.