Sr 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

Works with State Commercial Regulatory Review Team project managers and internal staff across multiple departments to identify data sources, processes and activities required to meet regulatory compliance requirements with a key focus on Utilization Review (UR) & Mental Health Parity (MHP) reporting.

Responsibilities

• Manage the UM/QM deliverables for state reporting and filings such as Mental Health Parity (MHP), Prior Authorization, Utilization Review or Licensure.
• Review and assess new or revised state legislation or mandates for potential impacts to National Clinical Services (NCS) and Quality Management (QM) state amendments.
• Manage and influence state-regulatory projects, activities and initiatives through design, development and ongoing implementation.
• Serve as a National, Regional or State Project Leader to oversee all aspects of project implementation.
• Manage QM/UM deliverables of all phases of state Market Conduct Exams and/or state Mental Health Parity Exams.
• Manage UM letter updates.
• Educate, consult and collaborate with unit business managers on state-specific QM and UM policies, procedures and activities.
• Mentor new or junior State Commercial UR/QM Regulatory Review Team staff regarding QM/UM program descriptions, work plans and evaluation activities.
• Actively seek opportunities for process improvement resulting in efficient and effective work streams.
• Manage complex relationships with both internal and external constituents.

Requirements

• UM, Clinical Claim Review (CCR), Mental Health Parity (MHP), Compliance, or QM project management experience.
• Ability to analyze and manage large amounts of data.
• Ability to manage multiple projects with overlapping deliverables and prioritize work.
• Strong collaboration and teamwork skills.
• Strong communication skills and the ability to interact with a variety of other departments.
• Strong Excel experience.
• Attention to detail, accuracy and overall quality.
• Adaptability and Time Management skills including: strong organizational skills, ability to maintain a positive attitude, self-motivated, and leadership qualities.

Preferred Qualifications

• Utilization Review (UR) and/or Clinical Claim Review (CCR) data experience.
• MedCompass and ATV experience.
• QuickBase experience.
• Legislation Review and process.

Qualifications

Bachelor's Degree or equivalent experience.

Schedule

Full time, 40 anticipated weekly hours.

Pay

The typical pay range for this role is $46,988.00 - $112,200.00. 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, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.