Job Description

Quality Management Professional

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. Aetna Better Health of Oklahoma, a CVS Health company, is a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way! This is a full-time teleworker opportunity in Oklahoma.

Continuous quality improvement is more than a buzzword it's how we meet customer needs and control costs. Through Quality Management professionals, we put industry-leading practices and principles to work in support of our quality objectives. Implements an all-product quality management strategy that meets internal and external constituent expectations for demonstrating quality outcomes. Using innovation, integration, and information links the quality management activities to business goals. Health Care Quality Management includes, but is not limited to, QM Programs/Infrastructure, behavioral health QM, credentialing, delegation and regulatory accreditation support, clinical and service measurement and improvement and quality of care investigations. Additional responsibilities to include but not limited to the following:

• Manages and leads committee activities to support meeting regulatory adherence and compliance.
• Participates in the development and ongoing implementation of QM Work Plan activities.
• Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives.
• Processes and evaluates complex data and information sets, performs quantitative and qualitative data analysis
• Prepares and completes QM documents based on interpretation and application of business requirements
• Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
• Assists in the development and implementation of QM projects and activities
• Accountable for completing and implementation of QM Work Plan Activities (e.g. QM committees, audits, clinical reviews)
• Prepares and reports business information to internal and external constituents and consults with constituents on solutions to business issues (e.g. delegates, committees, workgroups, regulators)
• Evaluates and makes recommendations for corrective actions regarding credentialing events and potential quality concerns
• Responsible for the ongoing maintenance and implementation of quality improvement projects and initiatives
• Performs other duties as required.

Required Qualifications

• Must reside in Oklahoma
• 3 years' work-related experience in the healthcare industry
• 2 years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• Must possess reliable transportation and be willing and able to travel 10% of the time in-state, based on business needs. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

• Medicaid Experience
• Quality Experience

Education

Bachelor's Degree or equivalent Work Experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $43,888.00 - $76,500.00

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.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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