We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
The Senior Quality Management Specialist leverages technology and data to improve healthcare outcomes by designing, implementing, and maintaining health information systems, analyzing quality healthcare data, and applying statistical analysis to create effectiveness analyses and other health outcomes analyses. This person applies expertise in healthcare and information technology to ensure efficient data management, promote data-driven insights, and enhance the delivery of healthcare services. Additionally, they will provide support in completing regulatory reporting requirements and contribute to the development and execution of HEDIS (Healthcare Effectiveness Data and Information Set) strategy, in order to ensure compliance and optimize performance in quality measurement initiatives.
General Responsibilities
- Leads the management of quality data, regulatory reporting, and analytics functions to enable internal teams to draw meaningful, actionable conclusions.
- Conducts literature reviews, as appropriate, to assess the current state of quality initiatives and ensure alignment with industry trends and benchmarks.
- Designs and develops dashboards and reporting solutions (e.g., Power BI, Tableau) to effectively communicate insights to a range of audiences, from operational teams to executive leadership.
- Defines and implements data models, statistical methodologies, and reporting frameworks to ensure accurate, reliable, and scalable data analysis.
- Translates analytical findings into clear business insights, informing decision-making and driving performance improvement across the Quality function.
- Performs quantitative and qualitative analyses to support achievement of NCQA (National Committee for Quality Assurance), HEDIS, Medicare Stars, and other quality performance metrics.
- Leads analysis of intervention effectiveness, including evaluation of program impact, return on investment, and contribution to measure performance improvement.
- Partners with clinical, operations, and quality leadership to inform measure-level strategy, including identification of performance gaps, prioritization of interventions, and ongoing optimization of improvement efforts.
- Provides analytical support for regulatory reporting (e.g., PIPs), including statistical analysis of interventions and evaluation of their impact on performance outcomes.
- Performs other duties as needed.
Required Qualifications
- 3+ years of experience with statistical analysis, including an ability to analyze and interpret data.
- 3+ years of experience in Microsoft Office Suite, especially Microsoft Excel and PowerPoint, as well as Tableau, SQL, and/or PowerBI (or similar dashboarding software).
Preferred Qualifications
- Previous experience in managed care or similar healthcare environment that includes HEDIS.
- Medicaid and/or Medicare managed care experience.
- Must be articulate and able to communicate to multiple internal and external stakeholders.
- Ability to collaborate effectively.
- Strong attention to detail.
- Ability to function successfully in an independent, self-driven environment.
- Excellent organizational and time management skills.
- Bachelor’s degree or higher.
Education
- Associate’s degree.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $122,400.00This 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 3+ years of experience with statistical analysis and data interpretation
- 3+ years of experience with Microsoft Office Suite, especially Excel and PowerPoint
- Experience with Tableau, SQL, Power BI, or similar dashboarding software
- Associate's degree
- Experience in managed care or a similar healthcare environment involving HEDIS
- Medicaid and/or Medicare managed care experience
- Articulate communication with internal and external stakeholders
- Ability to collaborate effectively
- Strong attention to detail
- Ability to work independently in a self-driven environment
- Excellent organizational and time management skills
- Bachelor's degree or higher
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
