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Health Care Quality Senior Manager
CVS Health
United States
Remote
USD 67,000 - 150,000
Full time
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Job summary
A leading health solutions company is seeking a Quality Management expert to develop and influence business strategies and improve quality outcomes. This role involves responsibility for quality management activities linked to business goals, requiring strong leadership and over 8 years of managed care experience.
Benefits
Qualifications
- 5+ years in a regulatory environment and/or quality management.
- 8+ years of managed care experience.
- Proficient in ROI analysis, SWOT, and program summarization.
Responsibilities
- Leads cross-functional teams to integrate quality into strategic plans.
- Evaluates recommendations for quality improvement.
- Develops and implements quality management program infrastructure.
Skills
Education
Tools
Job description
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
- Aggregative P4P opportunity achievement
- P4P opportunity achievement by plan
- Aggregative Performance Improvement Projects meeting “pass” criteria
Performance tracking for HEDIS measures
- 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 - $149,328.00At 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: 08/08/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.
Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at accessibility@talentify.io or 407-000-0000.
Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.
An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at aedt@talentify.io or 407-000-0000.
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