An integral member of the Quality Management HEDIS team, responsible for leading interdepartmental workgroups through to successful achievement of quality goals. Duties may include Performance Improvement Plan (PIP) writing, implementation, oversight, and analysis.
Works with internal staff across multiple departments to identify data sources, processes and activities required to meet regulatory and accreditation requirements or meet the objectives of the QM program.
- Leads interdepartmental groups in the development, implementation, and tracking of meaningful interventions which are ultimately reflected in increased rates of HEDIS and other Quality measures.
- May require budget development and staff supervision as it pertains to leading the groups and intervention programs.
- Delivers Quality information to internal and external constituents via written and verbal communication.
- May support training of new QM staff regarding program description, work plan and evaluation activities.
- Actively seeks opportunities for process improvement resulting in efficient and effective work streams.
- Utilizes data to analyze patterns of care in our membership, and to drive targeted interventions.
- Supports more complex relationships with both internal and external constituents.
- Consults with constituents on solutions to business issues including education and process improvement opportunities.
- Participates along with other QM team members on HEDIS medical record data collection during hybrid reporting season.
- 5 to 7 years clinical and/or managed care experience in the healthcare industry or quality management.
- 3 - 5 years' experience in healthcare or managed care quality management
- 3 - 5 years' experience leading groups of people to effect change
- Bachelor's degree, Nursing degree, or other comparable healthcare experience.
Bachelor's degree or equivalent experience
Percent of Travel Required
0 - 10%
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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