HEDIS Clinical Quality Analyst

Alliance Health

. Provide clinical direction, guidance, training, and quality oversight for HEDIS clinical activities .

Posted 10/12/2026full-timeMorrisville • North Carolina • United StatesMid-LevelSenior💰 $79,425 - $101,267 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in HEDIS clinical quality oversight, data analysis, and compliance with NCQA and CMS standards. Proficient in quality improvement activities and training development for healthcare professionals.

Highest-signal resume keywords

HEDIS Clinical Quality OversightNCQA Technical SpecificationsData Analysis and Quality ImprovementMedical Record AbstractionCertified Professional in Healthcare Quality (CPHQ)

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

HEDIS Data CollectionQuality AnalysisQuality Management ProgramsPerformance MeasurementRoot-Cause Analysis

Soft Skills

Interpersonal SkillsProblem-SolvingConflict ResolutionCommunication SkillsNegotiation Skills

Tools & Technologies

Microsoft ExcelMicrosoft WordMicrosoft PowerPointSPSSSurvey Monkey

Certifications & Qualifications

Registered Nurse (RN)Licensed Practical Nurse (LPN)Certified Professional in Healthcare Quality (CPHQ)

Industry Keywords

HEDIS MeasuresNCQA ComplianceMedicaid PopulationQuality ProgramsBehavioral Health

About the role

Key responsibilities & impact

Provide clinical direction, guidance, training, and quality oversight for HEDIS clinical activities
Oversee abstraction, overreads, and quality analysis for Prospective and Retrospective HEDIS seasons
Ensure compliance with NCQA and CMS standards
Perform quality improvement activities to monitor and maintain quality of care and regulatory compliance
Perform and coordinate HEDIS data collection, medical record review, and quality improvement activities
Serve as subject matter expert for NCQA HEDIS measures, including Hybrid, Administrative, and ECDS measures
Review HEDIS internal processes and plans for alignment with procedures and best practices
Participate in development, research, and implementation of HEDIS improvement activities
Plan implementation of Primary Source Verification and Medical Record Review Validation audits
Oversee abstraction quality assurance, second-level QA, and supplemental data audits
Interpret qualitative and quantitative information, document findings, and recommend improvements
Identify system and operational issues affecting quality performance standards
Motivate, influence, and direct staff assigned to Hybrid and supplemental data projects
Analyze technical specifications, business requirements, and regulatory guidance
Identify and escalate quality, compliance, and safety risks
Coordinate data analysis and quality interventions and report findings
Generate weekly and monthly HEDIS quality reports for directors, managers, and supervisors
Coordinate and oversee quality management programs and projects
Develop and implement quality management and error-reduction programs
Provide written feedback regarding performance, compliance risks, trends, root-cause analysis, and process improvements
Measure key output variables and assess performance changes
Analyze initial and repeat HEDIS measures to evaluate intervention efficacy
Evaluate supplemental data validity and accuracy
Analyze performance changes and impacts of interventions
Perform data analysis to evaluate gaps in care
Prepare comprehensive reports documenting findings and recommendations
Evaluate staff knowledge gaps and coordinate training
Create and update HEDIS training manuals, tip sheets, measure assessments, and pocket guides annually according to NCQA Technical Specifications
Monitor training effectiveness and outcomes

Requirements

What you’ll need

Graduation from an accredited school of nursing with a Registered Nurse (RN) license or Licensed Practical Nurse (LPN)
Five (5) years of healthcare experience in HEDIS clinical quality and process improvement
Experience with the NCQA Technical Specifications and Value Set Directory
Experience with Medical Record Abstraction/Quality Analysis and oversight of HEDIS-related duties, including supplemental data audit, Prospective audit and Hybrid audit
Knowledge of NCQA Health Plan HEDIS data collection and reporting requirements and processes
Understanding of operational requirements for data collection supporting HEDIS or similar Quality programs
Experience with the Medicaid population related to HEDIS Measures
Data analysis and IT infrastructure of standard and non-standard data related to supplemental data experience preferred
Certified Professional in Healthcare Quality (CPHQ) preferred
Knowledge of North Carolina State and Federal rules and requirements related to the service continuum in North Carolina
Knowledge of Tailored Plan, Integrated Care and Care Management processes and regulatory requirements
Knowledge of best and promising practices for behavioral and physical health and/or intellectual/developmental disabilities
Proficiency with Microsoft Excel, Word, PowerPoint, SPSS, and Survey Monkey or another online survey tool
Strong clinical, analytical, problem-solving, interpersonal, conflict-resolution, diplomacy, discretion, negotiation, and communication skills
Ability to resolve issues with minimal assistance

Benefits

Comp & perks

Medical, Dental, Vision, Life, Long Term Disability
Generous retirement savings plan
Flexible work schedules including hybrid/remote options
Paid time off including vacation, sick leave, holiday, management leave
Dress flexibility
Flexible work schedules
Hybrid/remote work options