Sr Analyst, Health Care Quality Management
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. Job Purpose and Summary: Accountable for Commercial, Medicare, Exchange and Medicaid NCQA Accreditation quality projects and initiatives through design, development, and implementation. This role focuses primarily on Delegated Credentialing and Oversight of the delegated Credentialing organizations, per contract. Proactively builds strong business relationships with internal and external business partners. Participates in presentation to business partners on accreditation requirements to achieve results and ensure accreditation readiness. Proven experience as a subject matter expert on NCQA accreditation standards, analysis, Delegated Credentialing file reviews and supporting quality functions.
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
Nice To Haves
- NCQA experience, preferred
- Auditing Experience, preferred
- College Education, preferred
Responsibilities
- Utilizes statistical analysis, data visualization tools, and database queries to identify trends, patterns, and opportunities for quality improvement.
- Develops and maintains performance metrics and dashboards to track and report on patient safety, clinical effectiveness, patient experience, and compliance with quality standards.
- Contributes to quality improvement projects and initiatives by providing data-driven insights and recommendations.
- Collaborates with cross-functional teams to design and implement evidence-based practices, care protocols, and process improvements.
- Assists in conducting audits and performing chart reviews to monitor compliance with regulatory requirements and quality standards.
- Prepares reports and presentations on quality metrics, performance trends, and improvement initiatives.
- Creates reports that encourage transparency by communicating findings to stakeholders, including leadership, providers, and other relevant teams in a comprehensive manner.
- Collaborates with various stakeholders to integrate new quality improvement efforts and facilitate the resolution of care coordination issues.
- Assists in developing and delivering training programs on quality management principles, best practices, and data visualization tools.
- Responsible for end-to-end delegated credentialing in accordance with all Aetna, HICE, NCQA, CMS, Medicaid and state requirements.
- Annual Oversight of delegated entities, which includes auditing, corresponding with delegates and working with HICE collaborative for pulling down audits.
- Interact with Aetna's Network Departments.
- Interact with delegated entities.
- Complete ongoing monitoring of corrective actions issued.
- Attending HICE Collaborative policy and scheduling meetings.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
