Senior Quality Management Specialist

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Oversee quality data management, regulatory reporting, and analytics operations.

• Perform literature reviews to evaluate quality initiatives and industry standards.

• Create and implement dashboards and reporting solutions utilizing tools like Power BI and Tableau.

• Establish and execute data models, statistical methods, and reporting frameworks.

• Convert analytical results into actionable business insights to drive performance enhancement.

• Conduct both quantitative and qualitative analyses for NCQA, HEDIS, Medicare Stars, and other quality metrics.

• Evaluate the effectiveness of interventions, program impacts, return on investment, and performance improvements.

• Collaborate with clinical, operational, and quality leadership on strategy for specific measures.

• Detect performance gaps and prioritize as well as optimize interventions.

• Deliver statistical analysis and evaluation assistance for regulatory reporting, including PIPs.

• Undertake additional responsibilities as required.

⛳️ Requirements

• Minimum of 3 years of experience in statistical analysis, with a strong ability to interpret and analyze data.

• At least 3 years of experience with the Microsoft Office Suite, particularly Microsoft Excel and PowerPoint.

• Proficient in Tableau, SQL, and/or Power BI or similar dashboard software.

• Previous experience in managed care or a comparable healthcare setting that includes HEDIS is preferred.

• Experience in Medicaid and/or Medicare managed care is preferred.

• Strong communication skills to engage with various internal and external stakeholders.

• Proven ability to work collaboratively with others.

• Exceptional attention to detail.

• Demonstrated capability to thrive in an independent, self-motivated environment.

• Excellent organizational and time management abilities.

• An Associate’s degree is required.

• A Bachelor’s degree or higher is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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