Analyst, Health Care Quality Management

CVS Health

. Conduct oversight audits of delegated entities contracted to perform credentialing functions on behalf of Aetna .

Posted 11/12/2026full-timeRemote • Illinois • United StatesMid-LevelSenior💰 $43,888 - $93,574 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in delegated credentialing and quality management within the healthcare industry, ensuring compliance with NCQA standards and federal regulations while effectively managing multiple priorities and maintaining detailed documentation.

Highest-signal resume keywords

Delegated Credentialing ExperienceQuality Management Strategy ImplementationNCQA Standards KnowledgeData Analysis SkillsStrong Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Credentialing FunctionsProcess Compliance EvaluationCorrective Action Plans DevelopmentQuantitative Data AnalysisQualitative Data AnalysisDocumentation SkillsOperational Workflow EvaluationQuality Management Work PlansRegulatory ComplianceAccreditation Readiness

Soft Skills

Attention to DetailOrganizational AbilitiesSelf-Motivated Team PlayerAdaptabilityEffective Prioritization

Tools & Technologies

MS ExcelMS WordAdobe Acrobat

Industry Keywords

Healthcare IndustryNCQA AccreditationFederal RegulationsState RegulationsContractual Requirements

About the role

Key responsibilities & impact

Conduct oversight audits of delegated entities contracted to perform credentialing functions on behalf of Aetna
Implement an all-product quality management strategy
Participate in the development and ongoing implementation of Quality Management work plans and activities
Evaluate process compliance and operational workflows for delegated credentialing functions
Evaluate adherence to NCQA standards, applicable federal and state regulations, and contractual requirements
Review and validate delegate-submitted reports, logs, and supporting materials
Ensure compliance and maintain readiness for NCQA accreditation
Develop and track corrective action plans
Assist in QM projects and activities
Document QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
Perform quantitative and qualitative data analysis to achieve operational targets
Prepare QM documents according to business requirements
Report business information to internal and external constituents and consult on solutions for emergent issues

Requirements

What you’ll need

Minimum of 2 years of delegated credentialing experience within 2–5 years of overall credentialing experience
3+ years of work-related experience in the healthcare industry or quality management
Strong computer skills including mastery of MS Excel, Word and Adobe Acrobat
Strong communication skills with external clients, primarily delegate entity contacts
Self-motivated team player who effectively manages multiple priorities and adapts to changing demands
Strong attention to detail and organizational abilities
Excellent documentation skills
Knowledge of NCQA standards, applicable federal and state regulations, and contractual requirements
Ability to work 40 hours per week

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being