Data Quality & Integration Analyst
ArcadiaSalary not specified
Full Time
Entry Level & New Grad, Junior (1 to 2 years)
$46,988 – $112,200Compensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, InsuranceIndustries
Requirements
Candidates must possess a clinical license as an LPN, LVN, or RN and reside in California. A minimum of 3 years of experience in Utilization Management and/or Case Management is required, with a Bachelor's degree preferred. Strong communication skills are essential for interacting with external clients, particularly regulatory and accreditation partners.
Responsibilities
The Senior Analyst will oversee external entities contracted for clinical functions on behalf of Aetna, monitoring their compliance with regulatory and NCQA requirements. They will communicate industry standards, Aetna policies, and best practices to improve quality programs and prepare delegation oversight evidence for reviews. This role also involves participating in industry collaboratives and supporting NCQA, CMS, and other regulatory compliance initiatives.
Skills
Utilization Management
Case Management
Delegation Auditing
Delegation Oversight
NCQA Requirements
Regulatory Compliance
Clinical Functions
Communication Skills
LPN
LVN
RN
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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