Senior Analyst, Health Care Quality Management

CVS Health

11d

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 Designs and implements a quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes, including National Committee for Quality Assurance (NCQA) and state regulators for Medicaid and CHIP. Links the quality management activities to business goals by using innovation, integration, and information. Participates in the development and ongoing implementation of Quality Management (QM) work plans and activities, including support of all accreditation activities and contract requirements. Analyzes and reports on findings on health plan activities and performance. Additional responsibilities include but not limited to the following: - Support accreditation minimally for health plan, health equity, and long term supports and services - Support quality contract requirements, including performance improvement projects (PIPs), analysis of quality improvement activities, and quality program evaluation - Measure adherence to clinical and preventive health guidelines - Assists in the development and implementation of QM projects and activities - Converts results of data analysis into meaningful business information to disseminate conclusions about the overall function of the department - Support quality committees execution and reporting to quality committees - Performs quantitative and qualitative data analysis to achieve operational targets - Prepares QM documents that adhere to the interpretation and application of business requirements

Requirements

• Candidate must reside in Florida (FL)
• 5 years experience in managed care quality and/or 3 years in Medicaid managed care
• Must be analytical and able to interpret data
• Must be proficient in all Microsoft office Suite, especially Microsoft Excel and PowerPoint
• Must be articulate and able to communicate to multiple internal and external stakeholders

Nice To Haves

• 1-2 years experience leading or managing performance improvement projects and/or Direct Quality National Committee for Quality Assurance (NCQA) accreditation
• 2 years Performance Improvement Projects (PIP) experience
• National Committee for Quality Assurance (NCQA) accreditation experience
• Medicaid managed care experience
• Master’s Degree

Responsibilities

• Support accreditation minimally for health plan, health equity, and long term supports and services
• Support quality contract requirements, including performance improvement projects (PIPs), analysis of quality improvement activities, and quality program evaluation
• Measure adherence to clinical and preventive health guidelines
• Assists in the development and implementation of QM projects and activities
• Converts results of data analysis into meaningful business information to disseminate conclusions about the overall function of the department
• Support quality committees execution and reporting to quality committees
• Performs quantitative and qualitative data analysis to achieve operational targets
• Prepares QM documents that adhere to the interpretation and application of business requirements

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