Analyst, Healthcare Quality Management - Must live in KS, VA, TX, KY, or IL

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.

Must live near one of the following areas :

• Dodge City / Garden City, KS
• Pittsburgh, KS
• Northern Are, VA
• Dallas, TX
• Lexington, KY
• Southern Region, IL

Position Summary

This Analyst Healthcare Quality Management will be a Quality Practice Liaison who builds positive relationships between Aetna Better Health (ABH) and its providers to facilitate high quality care for members.

The Quality Practice Liaison is responsible for providing education related to National Committee for Quality Assurance (NCQA) HEDIS measures, medical record documentation, and coding.

They will function as a liaison between Aetna Better Health providers and the health plan as a member of an internal, cross-functional team.

The Quality Practice Liaison role requires approximately 75% local travel to provider offices.

Required Qualifications

• Must reside in one of the following areas : Dodge City, Garden City, or Pittsburgh KS, the Northern VA area, Dallas TX, Lexington KY, or Southern, IL
• 2+ years of experience in direct patient care, social work, quality improvement or health coaching, preferably in a managed care environment
• 2 years provider facing activities / value based contracting / network
• Knowledge of HEDIS and Pay for Performance metrics, ICD-10 coding, Medicaid risk adjustment methodology, and common billing and common billing practices
• Strong analytical skills regarding HEDIS metrics and quality reporting
• Demonstrated understanding of Medicaid industry standards and NCQA requirements
• An ability to travel up to 75% across the assigned territory for in-person provider support
• Valid driver’s license in good standing and access to a reliable vehicle required with insurance.

Preferred Qualifications

• RHI, RHIT, CRC, or CPC certified Coder or auditor (CMAS) or RN or LPN or LISW
• Ability to manage relationships with an emphasis on internal and external mid-level relationships
• Ability to work across all levels of the organization, including working with executive audiences, vendors, and government as a customer
• Demonstrated ability to project manage and implement strategies to improve performance

Education

Bachelor’s Degree or equivalent experience

Pay Range

The typical pay range for this role is :

$40,600.00 - $89,300.00

This 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.