[Remote] Manager - Healthcare Quality at CVS Health

Michigan City, Mississippi, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

3+ years of quality improvement experience
Active Michigan nursing license or clinical license OR Certified Professional in Healthcare Quality
Experience with HEDIS, CMS Stars and CAHPS activities
Knowledge of NCQA accreditation standards
3+ years of program management experience
Bachelor’s degree in health-related field

Responsibilities

Support the functions of the Michigan Highly Integrated Duals Eligible (HIDE) quality program, including regulatory deliverables, HEDIS activities and reporting and other quality improvement activities
Be a collaborative partner with internal and external stakeholders to facilitate daily quality improvement (QI) functions
Coordinate and monitor quality improvement projects from inception to closure including quality withhold performance, NCQA accreditation and contract compliance
Develop the annual quality workplan to include program activities
Support population health management and health equity activities to address inequities aimed to reduce disparities
Monitor all workplan activities to ensure state, federal and NCQA compliance
Ensure all quality policies are updated annually and in compliance with state contract
Collaborate with all internal and external stakeholders to identify, develop, and implement innovative programs and initiatives to improve outcomes
Manage medical record review and compile reports for both committee presentation and state submission
Analyze data, develop reports and present to plan committees
Adhere to NCQA standards and work with the National Quality Management Accreditation team to maintain the plan’s NCQA accreditation
Support the coordination of corporate compliance and external surveys as needed
Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure
Active member of quality committees to drive improvement efforts
Participate in external quality review audits

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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