Analyst, Health Care Quality Management

Job not on LinkedIn

🔥 41 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $43.9k - $93.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Conduct oversight audits of delegated entities contracted to perform credentialing functions on behalf of Aetna • Implement an all-product quality management strategy • Participate in development and ongoing implementation of Quality Management work plans and activities • Evaluate process compliance and operational workflows for delegated credentialing functions • Evaluate adherence to NCQA standards, applicable federal and state regulations, and contractual requirements • Review and validate delegate-submitted reports, logs, and supporting materials • Ensure compliance and maintain readiness for NCQA accreditation • Develop and track corrective action plans • Assist in QM projects and activities • Document QM activities to demonstrate compliance with business, regulatory, and accreditation requirements • Perform quantitative and qualitative data analysis to achieve operational targets • Prepare QM documents • Report business information to internal and external constituents and consult on solutions for emergent issues

🎯 Requirements

• Minimum of 2 years of delegated credentialing experience within 2–5 years of overall credentialing experience (preferred) • 3+ years work related experience in the healthcare industry or quality management • Strong computer skills including mastery of MS Excel, Word and Adobe Acrobat • Strong communication skills with external clients, primarily delegate entity contacts • Strong attention to detail, organizational abilities, and excellent documentation skills (preferred) • Ability to manage multiple priorities and adapt to changing demands (preferred)

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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