CVS Health

Mgr, Strategic Analytics - HEDIS & Quality Data

Kentucky, United States

Not SpecifiedCompensation
Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health InsuranceIndustries

Requirements

Candidates must have 5+ years of experience in HEDIS, quality improvement, or healthcare data analysis, preferably within a health plan, health tech company, or consulting firm. Proven experience in a client-facing or consulting role is required, along with expert-level knowledge of HEDIS technical specifications and the NCQA reporting process. In-depth familiarity with Medicare Advantage STAR ratings and associated quality measures, as well as a strong understanding of health plan operational data including claims processing, clinical data exchange, and member/provider demographics, are essential. Proficiency in SQL and data visualization tools is also necessary.

Responsibilities

The Mgr, Strategic Analytics will serve as the primary point of contact for assigned clients, building strong relationships and conducting regular meetings to review performance and discuss strategic initiatives. Responsibilities include providing expert guidance on HEDIS quality measures, NCQA reporting, and STARs methodology, and translating complex data into actionable insights. The role involves analyzing large datasets to identify HEDIS gaps and performance trends, developing dashboards, performing root cause analysis, and collaborating with internal teams on data accuracy and tool development. Additionally, the position requires developing and recommending tailored strategies for HEDIS gap closure, monitoring their effectiveness, and staying current with HEDIS, NCQA, and CMS STARs requirements. Project management for multiple client projects, preparing detailed reports and presentations, and contributing to the development of best practices and scalable processes are also key duties.

Skills

HEDIS
NCQA reporting
STARs
Health plan data analysis
Claims data analysis
Encounter data analysis
Clinical data analysis
Gap analysis
Performance improvement strategies
Client relationship management
Data visualization
Strategic thinking
Problem-solving

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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