IME Quality Analyst
Blank StreetSalary not specified
Full Time
Entry Level & New Grad, Junior (1 to 2 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health SolutionsIndustries
Requirements
Candidates require 3 years of recent and related healthcare experience, with 1 year of Medicaid experience and/or 1+ years of HEDIS medical record abstraction experience. A Bachelor's Degree or equivalent experience in healthcare is necessary, along with expertise in HEDIS improvement work and prior experience in the healthcare industry, clinical, managed care, or quality management. Preferred qualifications include experience speaking with medical providers, recent HEDIS experience, Medicaid Stars or health insurance experience, and understanding of CPT/CPTII/ICD9/ICD10 coding and medical terminology.
Responsibilities
The Analyst, Health Care Quality Management implements an all-product quality management strategy, linking quality activities to business goals through innovation and integration. They participate in the development and implementation of QM work plans and activities, converting data analysis results into meaningful business information. Responsibilities include documenting QM activities for compliance, recommending corrective actions based on clinical analysis, performing quantitative and qualitative data analysis, preparing QM documents, reporting business information, and supporting HEDIS medical record capture and abstraction.
Skills
Quality Management
Data Analysis
Business Information
Regulatory Compliance
Clinical Analysis
HEDIS
Medical Record Review
Abstraction
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays
Risks
Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.
Differentiation
CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.
Upsides
Expansion of telehealth services allows CVS to reach more patients remotely.
Increased consumer interest in wellness boosts demand for CVS's health-related products.
The trend towards value-based care aligns with CVS's integrated healthcare approach.
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