Senior Analyst, Health Care Quality Management

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🔥 48 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $47k - $112.2k / year

⏰ Full Time

🟠 Senior

🧐 Business 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

• Work with State Commercial Regulatory Review Team project managers and internal staff across departments to identify data sources, processes and activities required for regulatory compliance • Manage UM/QM deliverables for state reporting and filings, including Mental Health Parity, Prior Authorization, Utilization Review and Licensure • Review and assess new or revised state legislation and mandates for impacts to National Clinical Services and Quality Management state amendments • Manage and influence state-regulatory projects, activities and initiatives through design, development and ongoing implementation • Serve as a National, Regional or State Project Leader overseeing project implementation • Manage QM/UM deliverables for state Market Conduct Exams and state Mental Health Parity Exams • Manage UM letter updates • Educate, consult and collaborate with business managers on state-specific QM and UM policies, procedures and activities • Mentor new or junior State Commercial UR/QM Regulatory Review Team staff • Seek process-improvement opportunities to create efficient and effective work streams • Manage complex relationships with internal and external constituents

🎯 Requirements

• Experience in UM, Clinical Claim Review, Mental Health Parity, Compliance or Quality Management project management • Ability to analyze and manage large amounts of data • Ability to manage multiple projects with overlapping deliverables and prioritize work • Strong collaboration and teamwork skills • Strong communication skills and ability to interact with various departments • Strong Excel experience • Attention to detail, accuracy and overall quality • Adaptability and time-management skills • Strong organizational skills • Ability to maintain a positive attitude • Self-motivated with leadership qualities • Utilization Review and/or Clinical Claim Review data experience preferred • MedCompass and ATV experience preferred • QuickBase experience preferred • Legislation review and process experience preferred • Bachelor's Degree or equivalent experience

🏖️ Benefits

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