Senior Analyst, Health Care Quality Management

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.

About the role

Provide consultation based on analysis and identification of key drivers of results, such as using data to identify clinical trends, analyze high-cost claimants, population health, and other clinical trends. Evaluate performance results, monitor engagement, and collaborate on opportunities for improvement. This role supports the highest standards of practice performance and quality within our organization's network of healthcare providers by identifying areas for quality improvement and partnering with provider practices to implement quality strategies that enhance care quality, cost efficiency, member and clinician experience, and drive positive patient outcomes.

Responsibilities

• Provider Engagement: Establish and maintain engagement with large provider groups.
• Performance Analysis: Conduct comprehensive analysis of provider performance metrics and clinical operations for value-based care (VBC) readiness and risk assessment. This includes clinical quality indicators, patient and provider satisfaction ratings, and operational efficiency measures. Identify areas of improvement and develop data-driven strategies to enhance provider performance and financial rewards.
• Provider Education: Collaborate with cross-functional teams to assess practice operations against industry best practices in primary care. Design and deliver training programs, workshops, and educational materials for primary care and specialty providers and their staff in key operational domains to achieve improved health outcomes. Facilitate sessions on clinic operations, quality standards, regulatory compliance, member experience, and patient-centered care to enhance provider skills and knowledge.
• Performance Improvement Initiatives: Lead initiatives aimed at improving provider performance. Develop and implement performance improvement plans, monitor progress, and evaluate the effectiveness of interventions in collaboration with practice partners.
• Quality Assurance: Conduct regular audits, reviews, and assessments of provider practices, documentation, and compliance. Provide feedback and recommendations for improvement.
• Stakeholder Collaboration: Collaborate closely with internal teams, including clinical and operational leadership, value-based care, quality management teams, and provider relations teams to align provider performance objectives with organizational goals. Foster effective working relationships with providers, offering guidance, feedback, and support to facilitate their success.
• Data Management and Reporting: Utilize data management systems and analytics tools to collect, analyze, and report provider performance data. Prepare comprehensive reports, dashboards, and presentations for senior leadership, highlighting key performance indicators, trends, and improvement opportunities.
• Industry Knowledge and Research: Stay abreast of industry trends, best practices, and regulatory changes related to provider performance and healthcare quality. Support population health and health equity initiatives to improve care gap closure rates and health outcomes. Conduct research and benchmarking activities to identify innovative approaches and opportunities for improvement.

Requirements

• Prior experience in the healthcare industry
• Prior clinical and/or managed care experience in the healthcare industry or quality management
• 1-2 years relevant work experience
• Experience developing presentations and working with data

Qualifications

• High School Diploma/G.E.D (minimum); Bachelor’s degree preferred
• Extensive Microsoft Excel experience (preferred)
• HEDIS knowledge (preferred)
• Certified Health Data Analyst (CHDA) (preferred)

Schedule

• Remote
• Monday-Friday, 8:00 AM - 5:00 PM
• Full-time (40 hours per week)

Pay

The typical pay range for this role is $46,988.00 - $91,800.00 annually. This pay range represents the 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 also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. Benefits include:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility