Analyst, Health Care QM - Work From Home

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 Analyst, Health Care QM plays a critical role in supporting the Practice Transformation team by helping to implement provider performance and quality management strategies that meets internal and external constituent expectations for demonstrating quality outcomes. This is achieved by innovation, integration, and using information that links the provider performance strategy and quality management activities to business goals. Position facilitates provider and member outreach to ensure member receipt of important clinical services to improvement member health outcomes. Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are noncompliant in the designated outreach services. Supports effective electronic medical record capture for HEDIS medical record review and abstraction of supplemental data. Key Responsibilities HEDIS/Health Outcomes Improvement: Identifies potential resources and initiates collaboration with team members and/or providers to improve member health outcomes and HEDIS measures. Member/Provider Outreach: Makes outbound calls to members and/or providers to assist members in obtaining services (i.e., provide reminders, make appointments, arrange transportation, etc.) to avoid delays in treatment and improve member health outcomes. Member Support: Identifies when to refer member to Social Worker or Case Manager. Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.) Provider Education/Performance Support: Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation. HEDIS Documentation/Data Support: Documents member participation in outreach activities in accordance with abstraction and audit standards. Conducts HEDIS provider chart request calls and mailings. May develop and maintain member incentive programs to support HEDIS initiatives, which could include activities such as maintaining incentive database to track member compliance. Community Collaboration: May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events). Works with internal staff to schedule, organize, and staff these events. Records and documents all member and provider outreach activity. Required Qualifications Minimum 3 years' recent and related health care marketing, outreach and/or health education experience. Ability to use standard corporate software packages and corporate applications. Strong communication skills and experience speaking with medical providers. Recent and related experience working with HEDIS criteria. Ability to work independently. Experience working in call center environment. Education Bachelor’s degree or equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $43,888.00 - $85,068.00 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. 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 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. For more information, visit We anticipate the application window for this opening will close on: 01/12/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. Apply tot his job