Clinical Quality Program Manager, HEDIS

Compliance, Quality & Regulatory
Remote
October 5, 2026
$95,000 - $115,000 / year
Contract Full Time Remote
Application ends: November 6, 2026

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Job Description

Location: Remote

We are seeking a Clinical Quality Program Manager, HEDIS to lead a full HEDIS season from planning through audit and deliver strong, accurate quality rates. This position is a full-time, six month contract engagement based remotely. The role oversees the medical record review project, manages chart abstraction staff, coordinates with the licensed auditor, and drives gap closure through provider outreach and validated supplemental data.

This role is well aligned for a quality professional who has successfully led a HEDIS season and brings a proactive, organized approach to every phase of the project. The ideal candidate builds a strong timeline early, keeps abstraction teams accurate and on pace, and partners confidently with auditors, providers, and plan leadership to achieve a smooth, well documented submission.

Responsibilities:

  • Manage the annual HEDIS medical record review project from planning through audit
  • Develop the project timeline and keep it aligned with auditor and submission deadlines
  • Recruit, train, and manage chart abstraction staff while monitoring abstraction accuracy
  • Conduct inter-rater reliability testing and provide coaching to maintain accuracy standards
  • Coordinate medical record retrieval from provider offices and health systems
  • Manage supplemental data sources and validate them to auditor standards
  • Monitor in-season rates and direct targeted interventions to strengthen measure performance
  • Coordinate provider outreach and gap closure campaigns during the measurement period
  • Prepare documentation and evidence for the NCQA HEDIS Compliance Audit
  • Serve as the primary contact for the licensed auditor throughout the engagement
  • Analyze final rates against benchmarks and prior year results and document key drivers
  • Deliver recommendations and documented processes for the following measurement year

Qualifications:

  • Bachelor’s degree preferred
  • Clinical licensure such as RN or LPN preferred
  • Minimum of 4 years of HEDIS, quality measurement, or Stars experience
  • Demonstrated experience managing a HEDIS medical record review season
  • Working knowledge of NCQA HEDIS technical specifications and audit requirements
  • Prior experience training and managing chart abstraction staff
  • Experience with supplemental data validation and standard supplemental data sources
  • Strong project management and vendor coordination skills

Schedule:

  • Full-time, six month contract engagement with potential for extension
  • Remote position
  • Monday through Friday, standard business hours ([Time Zone])
  • 40 hours per week

Salary Range: The salary range for this position is approximately $95,000 – $115,000 annually ($45.67 – $55.29 per hour), based on experience and qualifications.

Interview Process: Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

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