CVS Health

Sr Analyst, Health Care Quality Management, Medicaid - Work From Home

Posted on

April 11, 2025

Job Type

Full-Time

Role Type

Clinical Operations

License

RN

State License

Pennsylvania

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Help & Resources

Company Description

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.

Job Description

Requirements

Required Qualifications: RN or LPN Clinical Role 3-5 years of claims and policy support experience in the health care industry Excellent verbal and written communication skills Experienced in root cause analytics and identifying solutions Familiarity in performing claim analytics to validate industry standards Must be familiar with claim editing software to propose system changes Preferred Qualifications: Certified Coder a plus or commitment to become a CPC in one year of employment. QNXT Claim System Medicaid and Duals Lines of Business experience a plus Education: RN- USA Only LPN- USA Only

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Responsibilities

The ideal candidate will manage up to four health plans to support compliance with clinical policy, regulatory and accreditation guidelines. Candidate will coordinate the identification of potential claim editing, clinical program enhancements as well as provide support management of savings opportunities and vendor implementation.

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