Analyst, Health Care Quality Management - Work at Home

Clinical Quality Management Oversight Specialist

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This position will be working from home anywhere in the continental US.

Standard business hours Monday-Friday.

Accountable for conducting oversight of 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.

Accountable for preparing delegation oversight resources for NCQA and regulatory reviews.

This position supports NCQA, CMS, and other regulatory compliance initiatives.

Required Qualifications

3-5 years of experience in Quality Management within the healthcare industry

Demonstrated ability to consistently meet deadlines in a fast-paced environment

Strong communication and interpersonal skills, with a proven ability to collaborate effectively across teams

Preferred Qualifications

2 to 3 years prior experience working in Commercial / Medicare or Medicaid lines of business

Medical Terminology and Claims Experience

QuickBase Experience

Experience with flexing and shifting priorities

Experience working independently and collaboratively to solve problems, make decisions, and complete work / projects

Growth mindset (developing yourself and others) skills

Education

Bachelors Degree Preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is :

$43,888.00 - $102,081.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

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.