CVS Health · 2 hours ago
Health Quality Senior Manager
United States
Full-time
Remote
Senior Level
$75K/yr - $183K/yr
7+ years expCVS Health is dedicated to building a world of health around every individual, focusing on a connected and compassionate health experience. The Senior Manager, Health Quality is responsible for leading HEDIS related health care quality projects, developing quality improvement activities, and ensuring compliance with regulatory measures.
Health CareMedicalPharmaceuticalRetailSales
Responsibilities
Candidate builds strong business relationships, both internally and externally
Serves as a resource and subject matter expert (SME) on HEDIS, regulatory HEDIS quality measures of the quality program to develop and influence business strategies
Accountable for health care quality projects and initiatives through direction setting and leadership
Able to quantify quality management activities to business goals
Coordinates health care quality projects and initiatives through data, design, development, and implementation with intent to improve health care quality outcomes
Coordinates and designs the data collection methodology, target metrics, and data elements needed to measure outcomes of QI projects
Translates and delivers business information to internal and external constituents via formal presentations and/or written communications (e.g. delegates, committees, workgroups, regulators)
Develops documentation templates and systems to support QM projects and initiatives. Coordinates with cross functional workgroups to design and implement QI initiatives
May have supervisory responsibilities
Educates and consults with unit business managers on quality improvement methods (e.g., workflow, data analysis, metrics), serving as a technical resource and expert
Processes and evaluate complex data and information sets related to HEDIS and non-HEDIS quality measures for business needs
Performs quantitative and qualitative data analysis and reaches conclusions about the data
Prepares and completes QM documents based on interpretation and application of business requirements
Assists in the development and implementation of QM projects and QM Work Plan activities (e.g. QM committees, audits, medical record reviews, preventive health and wellness campaigns, etc.)
Evaluates and makes recommendations for corrective actions regarding consistent low-quality performance for network providers
Ensures maintenance of accurate documentation and reporting for quality improvement activities such as HEDIS reporting, surveys, regulatory audits, peer reviews, etc
Directs data collection for HEDIS and/or other quality reporting; identifies opportunities and infrastructure to improve operational efficiency across the organization for improvement based on results
Provides direction for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory requirements including oversight of outreach to members who are noncompliant in the designated outreach services
Manages effective medical record capture for HEDIS medical record review and abstraction of supplemental data. To include ECDS data capture
Supports collaboration with providers to improve member health outcomes and HEDIS measures
Develops and distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.)
Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation
May develop and maintain member incentive programs to support HEDIS initiatives
Maintains incentive database to track member compliance
May identify opportunities to partner with community organizations on special events and presentations (i.e., health fairs and community events). Works with internal staff to schedule, organize, and staff these events
Qualification
Required
7-10 years relevant work experience
Clinical and/or managed care experience in the healthcare industry or quality management
5+ years HEDIS data management experience
5+ years Project Management Experience / Regulatory Reporting
5+ years QSI = Converged Analytics experience (or other HEDIS engine software management experience)
5+ years navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
Adept at problem solving and decision making skills
Adept at collaboration and teamwork
Adept at growth mindset-agility and developing yourself and others
Adept at execution and delivery-planning, delivering, and supporting
CPHQ, Six Sigma, or PMP
Preferred
5+ years Medicaid or Medicare experience (preferred)
People management experience is preferred
Bachelor's degree preferred - or equivalent work experience
CPHQ, Six Sigma, or PMP preferred , but not required
Benefits
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.
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
The Motley Fool
2026-01-22
bloomberglaw.com
2026-01-22
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