[Hiring] Analyst, Health Care Quality Management @CVS Health

Role Description

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.

A Brief Overview

• Remote position - any location.
• Conduct oversight audits of delegated entities contracted to perform credentialing functions on behalf of Aetna.
• Implements an all-product quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes.
• Participates in the development and ongoing implementation of Quality Management (QM) work plans and activities.

What you will do

• Evaluate process compliance and operational workflows for delegated credentialing functions.
• Evaluate adherence to NCQA standards, applicable federal and state regulations, and contractual requirements.
• Review and validate the accuracy, completeness, and timeliness of delegate-submitted reports, logs, and supporting materials.
• Ensures compliance and maintains readiness for NCQA accreditation.
• Corrective actions plans and tracking.
• Works to achieve day-to-day objectives for the Health Care Quality Management (QM) function.
• Assists in the development and implementation of QM projects and activities.
• Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements.
• Performs quantitative and qualitative data analysis to achieve operational targets.
• Prepares QM documents that adhere to the interpretation and application of business requirements.
• Reports business information to internal and external constituents and consults on solutions for emergent issues.

Qualifications

• Minimum of 2 years of delegated credentialing experience within 2–5 years of overall credentialing experience.
• Self-motivated team player who effectively manages multiple priorities and adapts to changing demands.
• Demonstrates strong attention to detail, organizational abilities, and excellent documentation skills.

Requirements

• 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.

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, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process.

Company Description

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.