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At CVS Health, 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Implements an all-product quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes. Links the quality management activities to business goals by using innovation, integration, and information. Participates in the development and ongoing implementation of Quality Management (QM) work plans and activities.

Additional responsibilities to include but not limited to the following:

- Works to achieve day-to-day objectives for the Health Care Quality Management (QM) function.

- Assists in the development and implementation of QM projects and activities.

- Converts results of data analysis into meaningful business information to disseminate conclusions about the overall function of the department.

- Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements.

- Recommends corrective actions regarding credentialing events and potential quality concerns through clinical analysis.

- Performs quantitative and qualitative data analysis to achieve operational targets.

- Prepares QM documents that adhere to the interpretation and application of business requirements.

- Reports business information to internal and external constituents and consults on solutions for emergent issues.

- Supports effective medical record capture for HEDIS® medical record review and abstraction of supplemental data

Required Qualifications

- 3 years' recent and related health care experience in any setting

- 1 years of Medicaid experience and/or 1+ years of HEDIS medical record abstraction experience

- Subject Matter Expert in Healthcare Effectiveness Data and Information Set (HEDIS®) improvement work

- Prior experience in the healthcare industry.

- Prior clinical and/or managed care experience in the healthcare industry or quality management.

Preferred Qualifications

- Experience speaking with medical providers and/or medical office staff

- Recent and related experience working with HEDIS®

- Medicaid Stars experience or health insurance experience

- Health care related experience in clinical, managed care or quality management

- Understanding of CPT/CPTII/ICD9/ICD10 coding and medical terminology

Education

Bachelor’s Degree OR equivalent experience in Health Care

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 - $76,500.00

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 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 all 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 access 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 close on: 09/19/2025

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

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.