Senior Analyst, Health Care Quality Management

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Accountable for Commercial, Medicare, Exchange and Medicaid NCQA Accreditation quality projects and initiatives through design, development, and implementation • Focus primarily on Delegated Credentialing and Oversight of delegated Credentialing organizations, per contract • Build strong business relationships with internal and external business partners • Present accreditation requirements to business partners to achieve results and ensure accreditation readiness • Serve as a subject matter expert on NCQA accreditation standards, analysis, delegated credentialing file reviews and supporting quality functions • Utilize statistical analysis, data visualization tools, and database queries to identify trends, patterns, and opportunities for quality improvement • Develop and maintain performance metrics and dashboards covering patient safety, clinical effectiveness, patient experience, and compliance with quality standards • Contribute data-driven insights and recommendations to quality improvement projects and initiatives • Collaborate with cross-functional teams to design and implement evidence-based practices, care protocols, and process improvements • Assist with audits and chart reviews to monitor compliance with regulatory requirements and quality standards • Prepare reports and presentations on quality metrics, performance trends, and improvement initiatives • Communicate findings transparently to leadership, providers, stakeholders, and relevant teams • Integrate new quality improvement efforts and facilitate resolution of care coordination issues • Assist in developing and delivering training programs on quality management principles, best practices, and data visualization tools • Conduct annual oversight of delegated entities, including auditing, corresponding with delegates, and working with the HICE collaborative to pull down audits • Interact with Aetna Network Departments and delegated entities • Complete ongoing monitoring of corrective actions • Attend HICE Collaborative policy and scheduling meetings

🎯 Requirements

• Working knowledge of problem solving and decision making skills • 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 • Credentialing experience • High School Diploma or General Equivalent Development (GED), required • NCQA experience, preferred • Auditing Experience, preferred • College Education, preferred • 40 anticipated weekly hours

🏖️ 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