Senior Manager, Informatics

CVS Health

Work At Home, WA

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JOB DETAILS

SKILLS

Acceptance Testing, Administrative Skills, Agile Programming Methodologies, Big Data, Bug Tracking/Defect Management, Centers for Medicare and Medicaid Services (CMS), Cloud Computing, Communication Skills, Cross-Functional, Customer Experience, Data Analysis, Data Management, Data Processing, Data Sets, Data Warehousing, Detail Oriented, Documentation Standards, Establish Priorities, Federal Laws and Regulations, GCP (Good Clinical Practices), Geography, Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, IT Requirements, Incentive Programs, Informatics, Maintain Compliance, Medicaid, Medicare, Microsoft Exchange Server, Multitasking, National Committee for Quality Assurance (NCQA), Organizational Skills, Performance Management, Pivot Tables, Problem Solving Skills, Project Lifecycle, Project Planning, Project/Program Management, Quality Assurance, Quality Metrics, Regulations, Regulatory Compliance, Regulatory Reports, Regulatory Requirements, Relational Databases (RDBMS), Reporting Skills, Requirements Validation/Verification, Risk, Risk Analysis, SQL (Structured Query Language), Safety/Work Safety, Scrum Product Owner, State Laws and Regulations, Team Player, Technical Analysis, Technical Leadership, Technical/Engineering Design, Testing

LOCATION

Work At Home, WA

POSTED

4 days ago

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 position will support East Coast hours, starting by 9:00 am ET.**_ **Aetna Clinical Enablement (ACE)** has an exciting opportunity for a Senior Informatics Manager to join our HEDIS Data Enablement Team. The Healthcare Effectiveness Data and Information Set (HEDIS) is one of the most widely used healthcare quality data sets in the country. HEDIS reporting is a requirement for NCQA Health Plan Accreditation, CMS Medicare Advantage, Medicare Stars, Exchange, Medicaid, and many states. HEDIS measure results are used within the enterprise and externally to drive quality initiatives that improve the health of Aetna's members. The HEDIS Data Enablement Team is responsible for data management, supporting internal stakeholders, measure and run issue research and resolution, identifying measure and technology opportunities, providing HEDIS measure data and research to support initiatives, and the business owner for HEDIS data management for regulatory reporting. In this role, the Senior Informatics Manager will function as the central business liaison for the HEDIS Medicaid Business Unit, partnering with cross-functional teams to execute high-impact quality and regulatory initiatives. The role requires translating Medicaid business requirements into structured project plans, facilitating stakeholder alignment, and ensuring adherence to NCQA HEDIS technical specifications and state-level compliance standards. The Senior Informatics Manager will drive delivery across the full project lifecycle-requirements intake, build coordination, testing oversight, reporting validation, and post-implementation review-while proactively identifying risks and optimizing workflows to improve efficiency and performance outcomes. **Responsibilities** + Act as the primary liaison between the HEDIS Medicaid Business Unit and IT platform migration teams. + Lead and actively participate in IT business requirements sessions, translating Medicaid operational workflows and regulatory specifications into detailed, actionable system requirements. + Validate that technical design aligns with NCQA HEDIS specifications, CMS guidance, and state-specific Medicaid reporting requirements. + Provide formal business sign-off on requirements, build logic, and configuration decisions to ensure regulatory compliance and operational integrity. + Maintain deep understanding of Medicaid state reporting requirements, including state-specific measure variations, hybrid vs. administrative specifications, and submission formats. + Ensure migration decisions preserve measure integrity, numerator/denominator logic, stratifications, and audit documentation standards. + Evaluate proposed technical solutions and make informed decisions balancing regulatory risk, operational feasibility, and long-term scalability. + Oversee User Acceptance Testing (UAT), defect prioritization, and validation processes to ensure accurate measure output and reporting continuity. **The most successful candidates will display these traits:** + Expertise writing SQL queries to work with large complex data sets + Ability to understand and probe into technical processes and data + Experience working with health care data sources (enrollment, claims, lab, etc) + Be organized and exhibit attention to detail + Ability to manage conflicting priorities and multiple projects concurrently + Ability to work independently under general direction + Accountable for meeting commitments + Driven to provide an excellent customer experience for stakeholders. + Experience with Agile methodology in the Product Owner role + Successful track record of managing technical projects from discovery to delivery **Required Qualifications** + 5+ years of data analytics experience + 3+ years experience with health care data (enrollment, claims, lab) in a data warehouse environment + 3+ years experience using advanced SQL querying abilities in a large relational database environment including the ability to handle large datasets from multiple data sources + 3+ years experience creating reports and pivot tables in Excel + Ability to interpret technical specifications + Ability to communicate technical concepts to non-technical audiences (written and verbal) + Adept at probing into granular details of big data and complex technical processes + Strong problem solving skills and critical thinking ability + Strong collaboration and communication skills within and across teams **Preferred Qualifications** + Experience with HEDIS or other quality measurement program + Experience with Google Cloud Platform (GCP) administration + Experience with BigQuery data platform + Agile Product Owner experience **Education** Bachelor's Degree or equivalent work experience required **Pay Range** The typical pay range for this role is: $67,900.00 - $199,144.00 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. This position also includes an award target in the company's equity award program. 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 (https://learn.bswift.com/cvshealth-mainland) . We anticipate the application window for this opening will close on: 06/14/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.

About the Company

CVS Health

CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.

COMPANY SIZE

10,000 employees or more

INDUSTRY

Other/Not Classified

WEBSITE

https://cvshealth.com/