Health Care Quality Senior Manager

CVS Health Corporation; Georgia (VT); Remote; USD 67,000 - 150,000; Full time

Job summary

CVS Health is seeking a Health Care Quality Senior Manager to develop quality activities aligned with program goals. The role involves leading teams, evaluating quality improvement recommendations, and managing business processes to enhance operational efficiency. Candidates should have significant experience in regulatory environments and managed care, with a Bachelor's degree preferred. This position allows remote work from various states across the U.S., and offers a competitive salary and comprehensive benefits.

Benefits

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings and counseling programs

Paid time off and flexible work schedules

Tuition assistance and retiree medical access

Qualifications

• 5+ years of progressive experience in a regulatory environment.
• 8+ years of managed care experience.
• Proficiency in ROI analysis and program summarization.

Responsibilities

• Lead cross-functional teams to integrate quality into strategic plans.
• Provide comprehensive analysis of state PIPs and improvement efforts.
• Develop and implement the infrastructure of the QM program.

Skills

Regulatory environment experience

Quality management experience

ROI analysis

SWOT analysis

Power Point Infographic design

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

Health Care Quality Senior Manager page is loaded

Health Care Quality Senior Manager

Apply remote type Remote locations GA - Work from home Work At Home-Ohio Work At Home-Oklahoma Work At Home-Georgia Work At Home-Texas time type Full time posted on Posted 3 Days Ago time left to apply End Date: August 8, 2025 (30+ days left to apply) job requisition id R0610612

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.

*Candidate can be located anywhere in the United States"

Position Summary

Assimilating information to proactively develop quality activities aligned with program goals and objectives; linking the quality management activities to business goals; proactively building strong teams and business relationships, both internally and externally; and serving as a resource and subject matter expert on aspects of the quality program to develop and influence business strategies.

Responsibilities

· Assist in Making business decisions based on the results of research and data analysis

· Forms and leads cross functional teams to assist health plan departments in integrating quality into their strategic and operational plans

· Evaluates and prioritizes recommendations for quality improvement to senior health plan management

· Develops and implements the infrastructure of the QM program and patient safety strategy

· Directs/provides enhancements to business processes, policies, and infrastructure to improve operational efficiency across the organization

· Influences department business owners and leaders to reach solutions to meet the needs of stakeholders, internal and external

· Provides comprehensive analysis of state PIP's, barriers, and opportunities and presents results of improvement efforts and ongoing performance measures to plan management

· In partnership with business owners, supports design/development of new or enhanced products and services

Nested Analysis:

• Current star rating aggregate
• Current star rating by plan
• Current competitive ranking by plan
• Rate of VBC assigned members covered by QM staff
• Rate of VBC assigned members covered by QM staff by plan
• QM staff – group assignment aggregation
• Aggregative P4P opportunity achievement
• P4P opportunity achievement by plan
• Aggregative Performance Improvement Projects meeting “pass” criteria

Performance tracking for HEDIS measures

• Triple weighted
• MTMM
• MTTMM+
• Triple weighted by state
• MTMM by state
• MTTMM+ by state

Process Improvement Efforts

• Data and information collection from markets on recurring basis
• Data and information collection from markets on ad hoc basis
• Intervention data collection and research
• Monthly Market Data Meeting standard questions

Required Qualifications

· 5+ years of progressive experience in a regulatory environment and/or quality management

· At least 8+ years of managed care experience

· As well as, proficiency in:

• ROI analysis or SWOT
• Program summarization
• Power Point Infographic design and development

Preferred Qualifications
· Advanced Project Management skills and proficiency

· Proficiency with Microsoft Office Suite applications and other common computer and office software

Education:

Bachelor's degree preferred

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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 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: 08/08/2025

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

About us

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.