Analyst, Health Care Quality Management

Job not on LinkedIn

🔥 1 hour ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $43.9k - $93.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 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 the 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 according to business requirements • 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 • 3+ years of 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 • Self-motivated team player who effectively manages multiple priorities and adapts to changing demands • Strong attention to detail and organizational abilities • Excellent documentation skills • Knowledge of NCQA standards, applicable federal and state regulations, and contractual requirements • Ability to work 40 hours per week

🏖️ Benefits

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

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