Sr. Analyst, Medicare Strategy - Work From Home

Senior Manager Health Care Quality Management

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 Senior Manager Health Care Quality Management will be responsible for managing the Quality Program for the Florida Fully Integrated Duals Eligible (FIDE) plan. This involves oversight and execution of contractually required Medicare and Medicaid regulatory deliverables, HEDIS activities, quality improvement activities and internal and external reporting.

Key Responsibilities

• Quality Program / Plan Compliance : Develop the annual quality program (QAPI) trilogy documents (program description, workplan, program evaluation) in compliance with state and federal requirements. Monitor QAPI activities through supporting workplan management. Ensure all Integrated Duals Quality Policies comply with contract requirements. Support internal and external QAPI audits and surveys as needed. Adhere to NCQA standards and work with National Quality Management Accreditation team to maintain the plan's NCQA accreditation as required.
• Cross-Team Collaboration : Work with key stakeholders and key resources across the Integrated Duals and enterprise to develop, drive and deliver on QAPI program activities and initiatives. Coordinate and implement interventions to increase HEDIS, CAHPS, performance improvement projects and designated health measures to meet contract and plan goals.
• Reporting & Communication : Prepare and support the development of reports, presentations, and other documentation to communicate QAPI program outcomes and performance monitoring. This applies to internal and external plan partners. Develop data sets, KPIs, and other types of needed to execute the QAPI program ensure data accuracy and integrity to meet internal and regulatory requirements.
• Performance Evaluation & Recommendations : Assist in evaluating the QAPI program on an ongoing basis and support the QAPI program improvement process.

Required Qualifications

Preferred Qualifications

Education

Bachelor's Degree or equivalent experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is : $46,988.00 - $102,000.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Great Benefits for Great People

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 :

For more information, visit https : / / jobs.cvshealth.com / us / en / benefits

Application Deadline

We anticipate the application window for this opening will close on : 11 / 25 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.