Apply on Employer Site

CVS Health · 1 day ago

Analyst, Health Care QM - Work From Home

United States

Full-time

Remote

Mid Level

$44K/yr - $85K/yr

3+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Analyst, Health Care QM supports the Practice Transformation team by implementing provider performance and quality management strategies to improve member health outcomes and ensure compliance with quality initiatives.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Identifies potential resources and initiates collaboration with team members and/or providers to improve member health outcomes and HEDIS measures

Makes outbound calls to members and/or providers to assist members in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes

Identifies when to refer member to Social Worker or Case Manager

Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.)

Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation

Documents member participation in outreach activities in accordance with abstraction and audit standards

Conducts HEDIS provider chart request calls and mailings

May develop and maintain member incentive programs to support HEDIS initiatives, which could include activities such as maintaining incentive database to track member compliance

May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events)

Works with internal staff to schedule, organize, and staff these events

Records and documents all member and provider outreach activity

Qualification

HEDIS criteria experienceHealth care marketingCall center experienceCommunication skillsStandard corporate softwareWork independently

Required

Minimum 3 years' recent and related health care marketing, outreach and/or health education experience

Ability to use standard corporate software packages and corporate applications

Strong communication skills and experience speaking with medical providers

Recent and related experience working with HEDIS criteria

Ability to work independently

Experience working in call center environment

Bachelor's degree or equivalent experience

Benefits

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.