Senior Analyst, Health Care Quality Management

This is a fully remote position, open to applicants in California.

📋 Description

• Responsible for overseeing quality projects and initiatives related to Commercial, Medicare, Exchange, and Medicaid NCQA Accreditation through their design, development, and implementation.

• Primarily concentrate on Delegated Credentialing and the oversight of delegated Credentialing organizations as per contractual agreements.

• Foster robust business relationships with both internal and external business partners.

• Present accreditation requirements to business partners to achieve desired outcomes and ensure readiness for accreditation.

• Act as a subject matter expert on NCQA accreditation standards, conducting analyses, reviewing delegated credentialing files, and supporting quality functions.

• Employ statistical analysis, data visualization tools, and database queries to detect trends, patterns, and opportunities for enhancing quality.

• Create and sustain performance metrics and dashboards that encompass patient safety, clinical effectiveness, patient experience, and compliance with quality standards.

• Provide data-driven insights and recommendations for quality improvement projects and initiatives.

• Collaborate with cross-functional teams to develop and implement evidence-based practices, care protocols, and process enhancements.

• Assist in audits and chart reviews to ensure adherence to regulatory requirements and quality standards.

• Prepare reports and presentations detailing quality metrics, performance trends, and improvement initiatives.

• Clearly communicate findings to leadership, providers, stakeholders, and relevant teams.

• Integrate new quality improvement efforts and facilitate the resolution of care coordination issues.

• Assist in the creation and delivery of training programs focused on quality management principles, best practices, and data visualization tools.

• Conduct annual oversight of delegated entities, including auditing, corresponding with delegates, and collaborating with the HICE collective to obtain audits.

• Engage with Aetna Network Departments and delegated entities.

• Perform ongoing monitoring of corrective actions.

• Attend HICE Collaborative policy and scheduling meetings.

⛳️ Requirements

• Proficient problem-solving and decision-making skills.

• Minimum of 3 years of relevant experience in the healthcare industry or quality management.

• Strong proficiency in computer skills, particularly in MS Excel, Word, and Adobe Acrobat.

• Excellent communication skills, especially with external clients, predominantly delegate entity contacts.

• Experience in credentialing.

• High School Diploma or General Educational Development (GED) is required.

• NCQA experience is preferred.

• Experience in auditing is preferred.

• A college education is preferred.

• Anticipated weekly hours: 40.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program, alongside base pay.