This position supports key initiatives within HEDIS Outcomes by leading vendor-supported operations, medical record abstraction processes, cross-functional projects, and quality-focused implementations tied to HEDIS measures and technical specifications. This role is responsible for coordinating operational workflows, supporting data integrity, overseeing medical record uploads, managing vendor and repository relationships, and partnering across markets and business teams to drive successful execution.
The ideal candidate brings strong HEDIS measure experience and knowledge, as well as vendor experience, along with the ability to manage complex operational processes, collaborate across internal and external stakeholders, and support project execution in a fast-paced, highly regulated environment.
Key Skills for This Role
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Position Summary
This position supports key initiatives within HEDIS Outcomes by leading vendor-supported operations, medical record abstraction processes, cross-functional projects, and quality-focused implementations tied to HEDIS measures and technical specifications. This role is responsible for coordinating operational workflows, supporting data integrity, overseeing medical record uploads, managing vendor and repository relationships, and partnering across markets and business teams to drive successful execution.
The ideal candidate brings strong HEDIS measure experience and knowledge, as well as vendor experience, along with the ability to manage complex operational processes, collaborate across internal and external stakeholders, and support project execution in a fast-paced, highly regulated environment.
Key Responsibilities
Manage third-party vendor operations, monitoring compliance with all aspects of the SOW, supporting medical record abstraction, quality review, and special projects aligned with the NCQA Technical Specifications
Oversee calibration of offshore and onshore record review practices, including collaboration on HEDIS measure training, testing, abstraction, and documentation
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Establish and maintain vendor processes for medical record intake, internal workflow alignment, and reporting of results to providers
Support compliance and privacy-related coordination and negotiations tied to vendor processes, record access, and operational workflows
Develop, update, and maintain documentation, training guides, and standard operating procedures for internal teams and business partners
Monitor compliance with all aspects of the vendor SOW, intake and abstraction analytics, and regular reporting and leadership updates
Partner with the Vendor Management Organization to support and review Statements of Work, Requests for Proposal, staffing models, accounting considerations, and long-range workload forecasting aligned with HEDIS business needs
Coordinate staffing-related activities tied to offshore operations, including onboarding review, background check processes, Workday profile setup and updates, and staff transfers
Partner closely with Quality Management teams, Stars market partners, Engagement Managers, RN/PM specialists, and other business stakeholders to support audit readiness, research requests, special project management, and successful outcomes across abstraction operations
Required Qualifications
3 + years strong HEDIS measure experience and working knowledge of HEDIS technical specifications
3 + years’ experience managing HEDIS-related operations, medical record abstraction, quality review, or related healthcare quality initiatives
2 + year’s vendor management experience or equivalent
Demonstrated ability to analyze information, support reporting, and monitor data integrity
Strong organizational skills with the ability to manage multiple priorities in a fast-paced environment
Experience working across internal and external stakeholders to support operational execution and process improvement
Strong written and verbal communication skills
Proficiency in Microsoft Office applications, including Excel, PowerPoint, and Word
Ability to work EST due to areas covered
Preferred Qualifications
Project management experience in a vendor, healthcare, quality, or operational environment
Experience leading cross-functional projects involving vendors, data processes, and operational implementation
Experience working with medical record exchange technologies, repository vendors, or regulated data workflows
PMP certification or formal project management training preferred
Education
Bachelor’s Degree or Equivalent
Pay Range
The typical pay range for this role is:
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.
Additional details about available benefits are provided during the application process and on Benefits Moments .
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
About CVS Health
Retail300000 employeesFounded 1963
Diversified healthcare company integrating retail, pharmacy, and insurance services.
