Senior Manager - Health Quality

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 SummaryThe Senior Manager, Health Quality is responsible for HEDIS related health care quality projects and initiatives; assimilating information and data integration to develop quality improvement and management activities aligned with company strategies.

• 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

• Candidate may live anywhere in the United States
• Need to be flexible to work Central Time Zone hours as needed

• 5+ years 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

• 5+ years Medicaid or Medicare experience (preferred)
• People management experience is preferred

• Bachelor's degree preferred
• CPHQ, Six Sigma, or PMP preferred , but not required

• 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.