Senior Analyst, Health Care Quality Management, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

46988.00 - 112200.00 USD / Year

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Job Description:

Senior Analyst role focused on health care quality management, conducting oversight of external entities performing clinical functions for Aetna, ensuring compliance with regulatory and NCQA requirements.

Job Responsibility:

Accountable for conducting oversight of external entities that are contracted to perform clinical functions on Aetna's behalf
Monitor and track delegated entities compliance with regulatory and NCQA requirements
Communicate to delegated entities about industry standards, Aetna policies, and best practices to improve overall quality program
Accountable for preparing delegation oversight evidence for NCQA and regulatory reviews
Participate in industry collaboratives
This position supports NCQA, CMS, and other regulatory compliance initiatives

Requirements:

One of the following clinical licenses is required: LPN, LVN, or RN
Must reside in California
3+ years of Utilization Management and/or Case Management experience

Nice to have:

2+ years Delegation Auditing/Oversight experience
Strong communication skills with external clients, primarily regulatory and accreditation partners

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 27, 2025

Expiration:
October 07, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Analyst, Health Care Quality Management