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.
Position Summary
This quality leader:
- Facilitates collaborative clinical and operational performance improvement initiatives to achieve organizational HEDIS and STARs goals
- Develops, executes, analyzes and evaluates programmatic and workgroup interventions for improvement of HEDIS metrics via POSC
- Leads project management team that supports project and program analytics, interventions and evaluation processes including financial cost of care valuations
- Manages healthcare quality efforts by participating in quality data analysis, quality improvement projects, and regulatory compliance activities.
- Collaborates with the healthcare quality team to develop and implement quality measures, monitors performance metrics, and identifies areas for enhancement.
- Manages change and the successful execution of quality improvement initiatives and work towards promoting excellence in healthcare delivery.
- Develops and implements complex quality assurance programs and policies to enhance the delivery of clinical care.
- Assesses data, conducts audits, and monitors key performance indicators to measure clinical quality and patient outcomes.
- Ensures adherence to applicable laws, regulations, and accreditation standards by implementing compliance training programs, and conducting internal audits to identify potential compliance issues.
- Leads quality improvement projects, recommends changes to enhance efficiency, and drives initiatives to optimize clinical workflows, under minimal supervision.
- Delivers risk assessments, implements preventive measures, and develops strategies to address potential liabilities.
- Collaborates with clinical teams, including physicians, nurses, and other healthcare providers, to implement quality improvement initiatives and drive change.
- Provides training and education to clinical staff on quality-related topics, such as patient safety, infection control, and documentation practices, under general direction.
- Participates in committees and workgroups focused on healthcare quality and process improvement methodologies.
Required Qualifications
- 7+ years of relevant work experience
- Minimum of 3 years Quality or Case Management experience
- Strong knowledge of HEDIS measures and requirements
- Excellent data analytics and performance improvement skills
- Exceptional communication and interpersonal skills at varied organizational levels
Preferred Qualifications
Licensed clinician with 3-5 years clinical leadership or ambulatory care experience.
Education
Bachelor’s degree in a healthcare related field; masters degree and quality or PMP certification preferred
Pay Range
The typical pay range for this role is:
$82,940.00 – $182,549.00
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.
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We anticipate the application window for this opening will close on: 08/04/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.