Senior 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

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 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: 04/14/2026

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