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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

The Quality Improvement Operations Analyst acts as a liaison between the IT development group, business units, and providers (as needed) for the development and implementation of new systems and enhancement of existing systems. Evaluates opportunities in data for program growth. Project manages quality initiatives across stakeholders as needed to ensure outcome improvement across a variety of domains. Manages HEDIS reporting for the plan.

Essential Functions

• Conducts quantitative and qualitative analyses to assess business performance and identify opportunities for improvement.  
• Collects and analyzes business data to identify trends, patterns, and insights.  
• Develops basic process maps, flowcharts, and diagrams to document as-is and to-be processes.
• Conducts feasibility studies and cost-benefit analyses for proposed solutions and assesses potential solutions, technologies, or systems to address business needs.
• Assists in conducting impact assessments and addressing user concerns during implementation.  
• Conducts meetings, workshops, and presentations to gather feedback and validate requirements.
• Actively contributes to team meetings, brainstorming sessions, and collaborative projects, including sharing ideas, providing feedback, and contributing to the overall goals and objectives of the team.
• Contributes to the development and maintenance of standardized templates, guidelines, and methodologies.
• Build and maintain strong professional relationships internally and with leaders and staff of provider organizations.
• Assess current practice patterns, assets and challenges utilizing HEDIS, CAHPS, state, and regulatory standards
• Manages HEDIS reporting including monthly updates, review of specifications, managing performance of contract HEDIS measures.
• Use advanced communication, presentation, and facilitation skills to communicate the strategy needed to achieve the objectives for the provider group
• Track progress toward goals and objectives monthly and develop solutions and action plans for poor progress
• Assess and recommend new initiatives to assist providers in reaching their quality goals, including but not limited to enhanced usage of IT tools and various provider education trainings

Specific Duties

• Lead and facilitate workgroups both internally and externally to manage programs and measure key performance metrics
• Design, implement and execute internal and external training sessions on quality topics
• Develop and track progress of opportunities for member experience improvement to positively impact HEDIS and CAHPS scores
• Evaluate program for barriers and opportunities to make changes as appropriate
• Improve the understanding and sensitivity to the unique needs of ABH’s population and caregivers
• Multi-departmental collaboration for member and provider outreach activities
• Performs other duties and projects as assigned

Required Qualifications

• 2+ years’ experience in healthcare with a focus on HEDIS and Quality
• 1+ year of expertise in data analytics i.e. report writing, data analysis, data aggregation, data visualization, problem solving
• An ability to travel less than 10% across Ohio for in-person provider support. Valid driver’s license in good standing and access to a reliable vehicle required with insurance.

Preferred Qualifications

• Experience working in a behavioral health, residential, or psychiatric setting
• Demonstrated ability to project manage and implement strategies to improve performance
• Knowledge of HEDIS and Pay for Performance metrics, and common billing practices
• Strong analytical skills regarding HEDIS metrics and quality reporting
• Demonstrated understanding of Medicaid industry standards and NCQA requirements
• Ability to manage relationships with an emphasis on internal and external mid-level relationships
• Demonstrated experience in leading significant cross-functional work that includes business owners, executive leadership, and peers across the organization
• Ability to work across all levels of the organization, including working with executive audiences, vendors, and government as a customer
• Proficient in Microsoft Office tools such as Excel, Teams, Outlook, PowerPoint, and Word
• Articulate and professional communication skills, both verbally and written

Education

• Bachelor degree or 4+ years of relevant work experience

Pay Range

The typical pay range for this role is:

$72,306.00 - $155,736.00

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.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/27/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.