Quality Management Lead Director

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🔥 27 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

👔 Director

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Serve as the “voice of Quality” for the Louisiana market, leading all quality strategy and execution. • Own end-to-end performance for: HEDIS and hybrid measure performance, P4P / withhold maximization, CAHPS and member experience, Quality of Care and clinical outcomes. • Develop and execute market-specific strategies aligned to enterprise priorities and Measures That Matter Most (MTMM). • Lead and oversee the Louisiana QAPI and Continuous Quality Improvement (CQI) programs in alignment with contract requirements, State and federal regulations, NCQA accreditation standards. • Ensure readiness for NCQA surveys, EQRO audits, State audits and RFP evaluations. • Maintain documentation, policies, and reporting consistent with regulatory requirements. • Act as primary Quality contact with Louisiana Department of Health (LDH), External regulators and auditors, Provider partners and delegates. • Provide clinical oversight for Quality of Care investigations, Performance improvement projects (PIPs), Preventive health and population health initiatives. • Direct HEDIS and quality reporting, including Data collection and validation, Measure performance monitoring, Gap identification and closure strategies. • Lead provider performance strategy, including Value-Based Contracting (VBC) quality alignment, Provider education and engagement, Practice transformation initiatives. • Maintain full accountability for quality-related financial performance, including Withholds and incentive programs, Quality-related cost management. • Lead, develop, and mentor a multidisciplinary quality team, driving a culture of accountability, performance, and continuous improvement.

🎯 Requirements

• 10+ years of healthcare experience • 5–7+ years in managed care quality leadership • Demonstrated success leading HEDIS, accreditation, and quality performance programs • Strong knowledge of Medicaid regulatory requirements and quality frameworks • Proven ability to lead cross-functional teams and influence senior stakeholders • Excellent communication, executive presence, and strategic thinking skills • RN or clinical licensure; CPHQ or related certification

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families