HEDIS Clinical Quality Analyst

Alliance Health

HEDIS Clinical Quality Analyst overseeing clinical direction and quality oversight for HEDIS compliance. Role includes data analysis, training, and quality improvement activities.

Posted 7/17/2026full-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 collection, and compliance with NCQA and CMS standards. Proficient in quality improvement activities and medical record abstraction to enhance healthcare effectiveness.

Highest-signal resume keywords

HEDIS Clinical Quality OversightNCQA Technical SpecificationsMedical Record AbstractionQuality Improvement ActivitiesCertified Professional in Healthcare Quality

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisQuality AnalysisHealthcare ComplianceHEDIS Data CollectionProcess Improvement

Certifications & Qualifications

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

Industry Keywords

HEDISNCQACMSMedicaid PopulationQuality Management Programs

About the role

Key responsibilities & impact

Provides clinical direction, guidance, training, and quality oversight for clinical aspect of Healthcare Effectiveness Data and Information Set (HEDIS)
Oversees abstraction, overreads and quality analysis of HEDIS for both Prospective and Retrospective Seasons
Ensures compliance with the standards set by NCQA and CMS
Performs quality improvement activities to monitor/maintain quality of care and compliance
Coordinates HEDIS data collection, medical record review, and quality improvement activities
Participates in the development, research, and implementation of HEDIS improvement activities
Analyzes and interprets technical specifications, business requirements, and regulatory guidance to support accurate implementation of HEDIS measures
Coordinates and oversees all quality management programs/projects ensuring compliance with regulations

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
Knowledge of NCQA Health Plan HEDIS data collection and reporting requirements and processes
Understanding of the operational requirements for data collection in support of 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

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