POSITION SUMMARY/RESPONSIBILITIES

The Clinical Quality Improvement Manager leads the organization’s annual clinical quality monitoring and reporting activities for HEDIS, ensuring accurate, timely, and high‑quality data collection, analysis, and submission. This role provides strategic leadership to HEDIS data analysts and abstractors, oversees data integrity, and drives performance improvement by identifying trends, gaps, and opportunities across quality, preventive health, and disease management programs. Working closely with cross‑functional teams, the manager develops standardized workflows, reporting tools, and operational practices that strengthen HEDIS operations, support regulatory and accreditation compliance, and maintain audit‑ready performance across the organization.

EDUCATION/EXPERIENCE

Bachelor’s degree in nursing or a health-related field is required. Master’s degree in a health-related field is preferred. Thorough knowledge of health care regulations, accreditation standards, HEDIS, quality management, and process improvement are required. Data analysis or statistical analysis experience is preferred. Five years of clinical experience with healthcare analytics focused on HEDIS, data integrity, and performance measurement is preferred. Strong competency in data analysis tools—such as SQL, Tableau, or Power BI and familiarity with automated data-quality validation tools is preferred. Knowledge of managed care standards, and compliance with HIPAA and healthcare privacy regulations required. The role requires communication, project management, and problem‑solving skills to guide analysts and abstractors, optimize processes, and ensure accurate, audit‑ready HEDIS operations.

.

LICENSURE/CERTIFICATION

Must be licensed as a Registered Nurse in the State of Texas. Certification from an appropriate professional agency is required within one year of employment.