Sr Mgr,Health Care Qual Mgt

CVS Health



Frankfort, KY

Why you should apply for a job to CVS Health:

  • 62% say women are treated fairly and equally to men
  • 52% say the CEO supports gender diversity
  • Ratings are based on anonymous reviews by Fairygodboss members.


    Position summary

    ion, integration, and information links the quality management activities to business goals. Health Care Quality Management includes, but is not limited to, QM Programs/Infrastructure, behavioral health QM, credentialing, delegation and regulatory accreditation support, clinical and service measurement and improvement and quality of care investigations.

    Act as an Advocate for, and support, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of the care and service provided to our members. Lead and Manage all aspects of quality programs and projects that enable Aetna to measure, monitor, and improve the quality of the care and service provided to its members. Consult and/or work cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers. Responsible for coordinating, leading, and managing multiple functional areas/units including full accountability for business/financial results related to following as appropriate: HEDIS and CAHPS reporting, quality of care, accreditation activities and/or member satisfaction.

    Responsibilities include:

    • Responsible for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives. Makes business decisions based on the results of research and data analysis.

    • Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards.

    • Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc.

    • In conjunction with key business leaders, responsible for directing the activities of quality committees.

    • Provides direction setting and leadership, with accountability for quality program(s), specialized audits, special reviews, projects and initiatives.

    • Manage complex projects, people, and business priorities to achieve member satisfaction.

    • Develops and implements quality improvement activities nationally and/or within an assigned region.

    • Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results.

    • Influences all stakeholders to support key quality projects/programs to ensure positive solutions that deliver results. Consults with internal/external customers on solutions that impact Quality.

    • Controls expenses while meeting operational, functional and service requirements.

    • Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions.

    Required Qualifications

    • Experience with strategic planning, the Foster Care and juvenile justice systems, and Trauma-informed Care.

    • Must have and maintain training and experience in rapid cycle improvement.

    • Previous experience that reflects a proven track record or proficiency in the competencies noted.

    • Demonstrated verbal/written communication and computer skills.

    • Ability to work in a fast-paced environment.

    • Demonstrated ability to plan, organize, and execute multiple functional business objectives.

    • Previous experience managing staff

    • 5 to 7 years clinical and/or managed care experience in the healthcare industry and quality management.

    Preferred Qualifications

    • Certified Professional in Health Quality (CPHQ) or other certification a plus.


    • Master's degree preferred.

    • Bachelor's degree desired or comparable healthcare experience.

    Pay Range

    The typical pay range for this role is:

    $67,900.00 - $149,300.00

    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.

    In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

    For more detailed information on available benefits, please visit

    We anticipate the application window for this opening will close on: 06/21/2024

    Why you should apply for a job to CVS Health:

  • 62% say women are treated fairly and equally to men
  • 52% say the CEO supports gender diversity
  • Ratings are based on anonymous reviews by Fairygodboss members.