Quality Analyst

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary
- Responsible for quality audits and projects, etc associated with the Medicaid/Medicare unit's functional focus.

- Subject matter expert on workflows, policies, components of systems and on daily operations and programs

- Responsible to support targeted quality audit projects.

- Report results and make recommendations e.g., training needs, quality controls and procedures) In partnership with business owners, support the design and development of new processes

- Develop and implement quality programs and initiatives.

- Participate in the development and validation of desktops

- May develop and design data collection capability (e.g., customer surveys focus groups, system reports)

- Under direct supervision, develop and deliver training - May provide guidance or expertise to quality staff

- Facilitate team sessions to develop processes and/or resolve issues

- Support the creation of communication strategies and presentations for both internal and external customers to educate and address continuous quality improvement initiatives

- Analyze and resolve complex claims scenarios within established time frames - Identify and recommend internal and external benchmarks and appropriate measures for performance evaluation

- May, under supervision, develop quality assessment/audit/measurement programs tailored to specific assignments

- Analyze customer feedback and other measures.

Required Qualifications
1-2 year within the Medicaid / Medicare MSO department.

Experience with QNXT / Edifecs platform.

Preferred Qualifications

- Meeting/exceeding quality metrics

- Medicaid / Medicare Experience

- Attention to detail

- Good written and verbal communication

- Time managementEducation High school diploma or equivalentPay Range

The typical pay range for this role is:$18.50 - $42.35This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/17/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.