Position SummaryThe 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.
EducationAnticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$46,988.00 - $122,400.00
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 peopleWe 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 Benefits Moments.
We anticipate the application window for this opening will close on: 09/22/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
