Quality Data Specialist

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 Quality Data 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, as well as other health outcomes analyses. This person will apply expertise in healthcare and information technology to ensure efficient data management, promote data-driven insights, and enhance the delivery of healthcare services. They will also provide support in completing regulatory reporting requirements and contributes to the development and execution of HEDIS ( Healthcare Effectiveness Data and Information Set ) strategy to ensure compliance and optimize performance in quality measurement initiatives.Responsibilities include:

• Analyzing and interpreting complex Quality and HEDIS-related data, including healthcare quality measures, patient outcomes, and performance indicators, in order to support strategic initiatives and improve compliance with national benchmarks.
• Developing and implementing HEDIS strategy and quality assurance programs to ensure alignment with regulatory requirements, accreditation standards, and industry best practices.
• Conducting intervention analysis to evaluate the effectiveness of quality improvement initiatives, identify gaps in care, and recommend targeted actions to optimize outcomes.
• Performing routine audits and assessments to monitor adherence to company-established quality standards and regulatory reporting requirements, identifying core areas for improvement.
• Examining and reporting on quality measures, patient safety indicators, and HEDIS performance metrics to highlight areas of success and opportunities for improvement.
• Coordinating process mapping, root cause analysis, and workflow redesign to enhance healthcare processes, reduce errors, and improve efficiency.
• Applying in-depth knowledge and experience in external audits, surveys, and regulatory reporting, ensuring timely and accurate submission of required documentation to governing bodies.
• Preparing comprehensive reports and presentations to communicate findings, trends, and strategic recommendations to stakeholders, including senior leadership, quality improvement teams, and regulatory agencies

• 3+ years of experience with HEDIS and/or quality, specifically in a managed care, hospital, and/or similar healthcare environment.
• 3+ years of experience in Microsoft Office Suite, particularly Microsoft Excel and PowerPoint; SQL; and Tableau, PowerBI, and/or similar dashboarding software.
• 3+ years of experience in statistical analysis, analyzing and interpreting data, and communicating to multiple external and internal stakeholders.

• Previous experience with Medicaid and/or Medicare managed care.
• Excellent problem-solving skills.
• Excellent organizational and time management skills.

• Master's degree or equivalent experience (6 years of relevant experience + high school diploma or GED).

• 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.