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Healthcare Improvement Advisor - Medicaid and Exchanges

Company CVS Health
Location Woonsocket, RI
Update 5 Day ago
Position Summary:
As the US Healthcare system transitions from volume to value based payment models, health plans are increasingly measured and rewarded for their performance on Quality Programs. The Government Services Stars team at CVS Health plays a critical role in ensuring that our Medicaid, Exchange and Medicare health plan clients and SilverScript, a prescription drug benefit plan owned by CVS Health that serves over 4 million members, achieves superior performance on the highly visible and impactful Quality Rating programs.

As the Advisor of Healthcare Improvement for Medicaid and Exchange Markets, you will be a vital contributor to the success of CVS Health and our clients in achieving quality improvement goals. You will have the opportunity to provide insights that drive Quality Improvement results for Caremark clients by:

  • Scope, plan, and perform analyses that will yield critical answers and inform the strategic initiatives and policy advocacy to improve results on HEDIS and Exchange Quality Rating System measures for Managed Medicaid clients, Exchange clients, and potentially others affected by these measures
  • Understand and procure the required information to complete the analyses. Data will often be self-sourced through external research, interviews, and custom data pulls
  • Lead the delivery of timely, zero-defect analyses, articulate conclusions, and make recommendations to the leadership team and to clients
  • Design and deliver reports to monitor results. The reporting structure will support dedicated identification of areas for improvement, as well as inform recommendations regarding organizational remediation in operational and clinical areas to improve the overall ratings performance
The successful Advisor will master new programs or methodologies to quickly become a resource for colleagues and/or clients. You will also execute sophisticated analysis to identify creative and innovative solutions, recommending standard methodologies and enhancing business processes and tools. You will need to have the ability to operate in ambiguous environments in order to identify problems that could greatly impact the business. This position will have visibility to cross-functional leadership and will provide support to Caremark's Sales and Account Services division regarding the measurement ratings performance, regulatory changes and on-going improvement initiatives. Finally, you will use your technical acumen to communicate technical issues/requirements in a succinct and clear way. The contributions you will make as an Advisor of Healthcare Improvement will position CVS Health as a leader in client satisfaction and service in the PBM marketplace.

Required Qualifications:
  • 8+ years of project management leadership with moderate resource requirements, risk, and/or complexity with strong attention to detail, within a highly regulated industry.
  • 5+ years of demonstrated advanced use of Microsoft Word, Excel, Access and PowerPoint.
Preferred Qualifications:
  • Previous experience in the government payer or Quality Measures environment.
Bachelor's degree is required; equivalent work experience may substitute.

MBA is preferred.

Business Overview:
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster:


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