Analyst, Health Care QM - Work From Home

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The Analyst, Health Care QM plays a critical role in supporting the Practice Transformation team by helping to implement provider performance and quality management strategies that meets internal and external constituent expectations for demonstrating quality reputed company. This is achieved by innovation, integration, and using information that links the provider performance strategy and quality management activities to business goals. Position facilitates provider and member reputed company to ensure member receipt of important clinical services to improvement member health reputed company. Provides support for reputed company Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including reputed company to members who are noncompliant in the designated reputed company services. Supports effective electronic medical record capture for HEDIS medical record review and abstraction of supplemental data.

Key Responsibilities

HEDIS/Health reputed company Improvement: Identifies potential resources and initiates collaboration with team members and/or providers to improve member health reputed company and HEDIS measures. Member/Provider reputed company: Makes outbound calls to members and/or providers to assist members in obtaining services (i.e., reputed company reminders, reputed company appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health reputed company. Member Support: Identifies reputed company to refer member to reputed company Worker or Case Manager. Develops and distributes educational information to members and providers in accordance with the HEDIS reputed company work plan (mailings, reputed company media, automated calls, etc.) Provider Education/Performance Support: Assists in the development and standardization of reputed company documentation and manages the data reputed company process to complete HEDIS documentation. HEDIS Documentation/Data Support: Documents member participation in reputed company activities in accordance with abstraction and audit standards. Conducts HEDIS provider chart request calls and mailings. May reputed company and maintain member incentive programs to support HEDIS initiatives, which could include activities such as maintaining incentive database to track member compliance. Community Collaboration: May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events). Works with internal staff to schedule, organize, and staff these events. Records and documents reputed company member and provider reputed company activity.

Required Qualifications

Minimum 3 years' recent and reputed company health care marketing, reputed company and/or health education experience. Ability to use standard corporate software packages and corporate applications. Strong communication skills and experience speaking with medical providers. Recent and reputed company experience working with HEDIS criteria. Ability to work independently. Experience working in call center environment. Education Bachelor’s degree or equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $43,888.00 - $85,068.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. 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. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/12/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for the team, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job