Job Description: Quality Management Lead

Employment Type: Full-time

Location Type: Candidate can be located anywhere in the United States

Salary: $67,900.00 - $149,328.00 (This pay range represents the base hourly rate or base annual full-time salary. 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.)

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Position Overview

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.

This role involves assimilating information to proactively develop quality activities aligned with program goals and objectives; linking 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.

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Responsibilities

• Assist in making business decisions based on the results of research and data analysis.
• Form and lead cross-functional teams to assist health plan departments in integrating quality into their strategic and operational plans.
• Evaluate and prioritize recommendations for quality improvement to senior health plan management.
• Develop and implement the infrastructure of the QM program and patient safety strategy.
• Direct/provide enhancements to business processes, policies, and infrastructure to improve operational efficiency across the organization.
• Influence department business owners and leaders to reach solutions to meet the needs of stakeholders, internal and external.
• Provide comprehensive analysis of state PIP's, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to plan management.
• In partnership with business owners, support 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 a recurring basis
• Data and information collection from markets on an ad hoc basis
• Intervention data collection and research
• Monthly Market Data Meeting standard questions

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Required Qualifications

• 5+ years of progressive experience in a regulatory environment and/or quality management.
• At least 8+ years of managed care experience.
• Proficiency in ROI analysis or SWOT.
• Proficiency in Program summarization.
• Proficiency in PowerPoint Infographic design and development.

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Preferred Qualifications

• Advanced Project Management skills and proficiency.
• Proficiency with Microsoft Office Suite applications and other common computer and office software.

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Education

• Bachelor's degree preferred.

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Company Information

Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve.