Sr Analyst, Health Care Quality Management, Medicaid - Work From Home

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. Position Summary The ideal candidate will manage up to four health plans to support compliance with clinical policy, regulatory and accreditation guidelines. Candidate will coordinate the identification of potential claim editing, clinical program enhancements as well as provide support management of savings opportunities and vendor implementation. Required Qualifications • RN or LPN Clinical Role • 3-5 years of claims and policy support experience in the health care industry • Excellent verbal and written communication skills • Experienced in root cause analytics and identifying solutions • Familiarity in performing claim analytics to validate industry standards • Must be familiar with claim editing software to propose system changes Preferred Qualifications • Certified Coder a plus or commitment to become a CPC in one year of employment. • QNXT Claim System • Medicaid and Duals Lines of Business experience a plus Education • RN- USA Only • LPN- USA Only 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. 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: • 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. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 05/01/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply Job!