Sr Analyst, Health Care Quality Management

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.

Job Purpose and Summary:

Accountable for Commercial, Medicare, Exchange and Medicaid NCQA Accreditation quality projects and initiatives through design, development, and implementation. This role focuses primarily on Delegated Credentialling and Oversight of the delegated Credentialling organizations, per contract. Proactively builds strong business relationships with internal and external business partners.   Participates in presentation to business partners on accreditation requirements to achieve results and ensure accreditation readiness. Proven experience as a subject matter expert on NCQA accreditation standards, analysis, Delegated Credentialing file reviews and supporting quality functions.

Primary Job Duties & Responsibilities:

Utilizes statistical analysis, data visualization tools, and database queries to identify trends, patterns, and opportunities for quality improvement.

Develops and maintains performance metrics and dashboards to track and report on patient safety, clinical effectiveness, patient experience, and compliance with quality standards. Contributes to quality improvement projects and initiatives by providing data-driven insights and recommendations.  Collaborates with cross-functional teams to design and implement evidence-based practices, care protocols, and process improvements. Assists in conducting audits and performing chart reviews to monitor compliance with regulatory requirements and quality standards. Prepares reports and presentations on quality metrics, performance trends, and improvement initiatives.  Creates reports that encourage transparency by communicating findings to stakeholders, including leadership, providers, and other relevant teams in a comprehensive manner.  Collaborates with various stakeholders to integrate new quality improvement efforts and facilitate the resolution of care coordination issues.  Assists in developing and delivering training programs on quality management principles, best practices, and data visualization tools.

The Healthcare Quality Management Sr Analyst will be responsible for end-to-end delegated credentialing in accordance with all Aetna, HICE, NCQA, CMS, Medicaid and state requirements. This will include:
-Annual Oversight of delegated entities, which includes auditing, corresponding with delegates and working with HICE collaborative for pulling down audits.
-Interact with Aetna's Network Departments.
-Interact with delegated entities

-Complete ongoing monitoring of corrective actions issued.

-Attending HICE Collaborative policy and scheduling meetings

Required Qualifications

• Working knowledge of problem solving and decision making skills
• 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.
• Credentialing experience

Preferred Qualifications:

• NCQA experience, preferred
• Auditing Experience, preferred

Education

• High School Diploma or General Equivalent Development (GED), required
• College Education, preferred
• Prior Relevant Work Experience 3-5 years

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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. 
 

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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. The benefits for this position 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 and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/30/2026

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