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Must reside near one of the following areas:

• Wichita/Great Bend, KS

• Shreveport, LA

• Charlottesville, VA

• San Antonio, TX

• Southern, IL

Position Summary

This Senior 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 live near one of the following areas: Wichita/Great Bend KS, Shreveport LA, Charlottesville VA, San Antonio TX, and Southern, IL

• 3+ years of experience with managed care - direct patient care, social work, quality improvement or health coaching

• Experience with coding

• 3+ years provider facing activities/valued 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

• One of the following license/certifications: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS, RHI, RHIT, CRC, or CPC

• 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:

$43,700.00 - $107,200.00

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. 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 jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 05/30/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.