Analyst, Health Care QM - Work From Home

Analyst, Health Care QM - Work From Home

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.

The Analyst, Health Care QM plays a critical role in supporting the Practice Transformation team by helping to implement provider performance and quality management strategies that meets internal and external constituent expectations for demonstrating quality outcomes. This is achieved by innovation, integration, and using information that links the provider performance strategy and quality management activities to business goals. Position facilitates provider and member outreach to ensure member receipt of important clinical services to improvement member health outcomes.

Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services. Supports effective electronic medical record capture for HEDIS medical record review and abstraction of supplemental data.

• Identify potential resources and initiate collaboration with team members and/or providers to improve member health outcomes and HEDIS measures.
• Make outbound calls to members and/or providers to assist members in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes.
• Identify when to refer member to Social Worker or Case Manager; develop and distribute educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.).
• Assist in the development and standardization of outreach documentation and manage the data flow process to complete HEDIS documentation.
• Document member participation in outreach activities in accordance with abstraction and audit standards; conduct HEDIS provider chart request calls and mailings; develop and maintain member incentive programs to support HEDIS initiatives, including maintaining incentive database to track member compliance.
• Identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events); work with internal staff to schedule, organize, and staff these events; record and document all member and provider outreach activity.

• Minimum 3 years’ recent and related health care marketing, outreach and/or health education experience.
• Ability to use standard corporate software packages and corporate applications.
• Strong communication skills and experience speaking with medical providers.
• Recent and related experience working with HEDIS criteria.
• Ability to work independently.
• Experience working in call center environment.

• Bachelor’s degree or equivalent experience.

40

Full time

$43,888.00 - $85,068.00

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.

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

We anticipate the application window for this opening will close on: 01/12/2026

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