Senior Analyst, Health Care Quality Management

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

This is a telework role but must reside in the state of California.
Up to 10% of travel within the state of California required.
Schedule is Monday-Friday, standard business hours.

Roles and Responsibilities:

• Accountable for conducting oversight of external entities that are contracted to perform clinical functions on Aetna's behalf.
• Monitor and track delegated entities compliance with regulatory and NCQA requirements.
• Communicate to delegated entities about industry standards, Aetna policies, and best practices to improve overall quality program.
• Accountable for preparing delegation oversight evidence for NCQA and regulatory reviews.
• Participate in industry collaboratives.
• This position supports NCQA, CMS, and other regulatory compliance initiatives.

Required Qualifications

• One of the following clinical licenses is required: LPN, LVN, or RN
• Must reside in California
• 3+ years of Utilization Management and/or Case Management experience

Preferred Qualifications

• 2+ years Delegation Auditing/Oversight experience
• Strong communication skills with external clients, primarily regulatory and accreditation partners

Education

• Bachelors degree preferred
• CA clinical licensure required

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$46,988.00 - $112,200.00

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 https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/07/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.