Position Summary
This position supports key initiatives within HEDIS Outcomes by leading vendor-supported operations, medical record abstraction processes, cross-functional projects, and quality-focused implementations tied to HEDIS measures and technical specifications. This role is responsible for coordinating operational workflows, supporting data integrity, overseeing medical record uploads, managing vendor and repository relationships, and partnering across markets and business teams to drive successful execution.
The ideal candidate brings strong HEDIS measure experience and knowledge, as well as vendor experience, along with the ability to manage complex operational processes, collaborate across internal and external stakeholders, and support project execution in a fast-paced, highly regulated environment.
Key Responsibilities
- Manage third-party vendor operations, monitoring compliance with all aspects of the SOW, supporting medical record abstraction, quality review, and special projects aligned with the NCQA Technical Specifications
- Oversee calibration of offshore and onshore record review practices, including collaboration on HEDIS measure training, testing, abstraction, and documentation
- Establish and maintain vendor processes for medical record intake, internal workflow alignment, and reporting of results to providers
- Support compliance and privacy-related coordination and negotiations tied to vendor processes, record access, and operational workflows
- Develop, update, and maintain documentation, training guides, and standard operating procedures for internal teams and business partners
- Monitor compliance with all aspects of the vendor SOW, intake and abstraction analytics, and regular reporting and leadership updates
- Partner with the Vendor Management Organization to support and review Statements of Work, Requests for Proposal, staffing models, accounting considerations, and long-range workload forecasting aligned with HEDIS business needs
- Coordinate staffing-related activities tied to offshore operations, including onboarding review, background check processes, Workday profile setup and updates, and staff transfers
- Partner closely with Quality Management teams, Stars market partners, Engagement Managers, RN/PM specialists, and other business stakeholders to support audit readiness, research requests, special project management, and successful outcomes across abstraction operations
Required Qualifications
- 3 + years strong HEDIS measure experience and working knowledge of HEDIS technical specifications
- 3 + years’ experience managing HEDIS-related operations, medical record abstraction, quality review, or related healthcare quality initiatives
- 2 + year’s vendor management experience or equivalent
- Demonstrated ability to analyze information, support reporting, and monitor data integrity
- Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
- Experience working across internal and external stakeholders to support operational execution and process improvement
- Strong written and verbal communication skills
- Proficiency in Microsoft Office applications, including Excel, PowerPoint, and Word
- Ability to work EST due to areas covered
Preferred Qualifications
- Project management experience in a vendor, healthcare, quality, or operational environment
- Experience leading cross-functional projects involving vendors, data processes, and operational implementation
- Experience working with medical record exchange technologies, repository vendors, or regulated data workflows
- PMP certification or formal project management training preferred
Education
- Bachelor’s Degree or Equivalent
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,300.00 - $132,600.00
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.
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.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on .
We anticipate the application window for this opening will close on: 09/18/2026
