Sr Analyst, Health Care Quality Management

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary
Works with State Commercial Regulatory Review Team project managers and internal staff across multiple departments to identify data sources, processes and activities required to meet regulatory compliance requirements with a key focus on Utilization Review (UR) & Mental Health Parity (MHP) reporting.

Fundamental components:

• Manage the UM/QM deliverables for state reporting and filings such as Mental Health Parity (MHP), Prior Authorization, Utilization Review or Licensure.
• Review and assess new or revised state legislation or mandates for potential impacts to National Clinical Services (NCS) and Quality Management (QM) state amendments.
• Manage and influence state-regulatory projects, activities and initiatives through design, development and ongoing implementation.
• Serve as a National, Regional or State Project Leader to oversee all aspects of project implementation.

Other responsibilities may include:

• Manage QM/UM deliverables of all phases of state Market Conduct Exams and/or state Mental Health Parity Exams.
• Manage UM letter updates
• Educate, consult and collaborate with unit business managers on state-specific QM and UM policies, procedures and activities.
• Mentor new or junior State Commercial UR/QM Regulatory Review Team staff regarding QM/UM program descriptions, work plans and evaluation activities.
• Actively seek opportunities for process improvement resulting in efficient and effective work streams.
• Manage complex relationships with both internal and external constituents.

Required Qualifications

• UM, Clinical Claim Review (CCR), Mental Health Parity (MHP), Compliance, or QM project management experience.
• Ability to analyze and manage large amounts of data.
• Ability to manage multiple projects with overlapping deliverables and prioritize work.
• Strong collaboration and teamwork skills.
• Strong communication skills and the ability to interact with a variety of other departments.
• Strong Excel experience.
• Attention to detail, accuracy and overall quality.
• Adaptability and Time Management skills including: strong organizational skills, ability to maintain a positive attitude, self-motivated, and leadership qualities.

Preferred Qualifications

• Utilization Review (UR) and/or Clinical Claim Review (CCR) data experience
• MedCompass and ATV experience
• QuickBase experience
• Legislation Review and process

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:

$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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/13/2026

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