Senior Analyst, Health Care Quality Management

CVS Health

1d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This is a telework role but must reside in the state of California. Up to 10% of travel within the state of California required. Schedule is Monday-Friday, standard business hours.

Requirements

• One of the following clinical licenses is required: LPN, LVN, or RN
• Must reside in California
• 3+ years of Utilization Management and/or Case Management experience
• CA clinical licensure required

Nice To Haves

• 2+ years Delegation Auditing/Oversight experience
• Strong communication skills with external clients, primarily regulatory and accreditation partners
• Bachelors degree preferred

Responsibilities

• Accountable for conducting oversight of external entities that are contracted to perform clinical functions on Aetna's behalf.
• Monitor and track delegated entities compliance with regulatory and NCQA requirements.
• Communicate to delegated entities about industry standards, Aetna policies, and best practices to improve overall quality program.
• Accountable for preparing delegation oversight evidence for NCQA and regulatory reviews.
• Participate in industry collaboratives.
• This position supports NCQA, CMS, and other regulatory compliance initiatives.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level