Quality Project Manager, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Quality Control

Contract Type:
Employment contract

Salary:

60300.00 - 132600.00 USD / Year

Save Job

Apply Position

Job Description:

Supportive of State of Michigan Quality Contract deliverables, QAPI Program and regulatory standards. Processes and evaluates complex data and information sets in the development of strategic solutions to business issues and initiatives through direction setting and project management work.

Job Responsibility:

Works with Director of Quality to assist in making business decisions based on the results of research and data analysis
Leads cross functional teams to assist the health plan departments in integrating quality into their strategic and operational plan
Evaluates and prioritizes recommendations for quality improvement to senior health plan management
Helps to evaluate the Plans HEDIS Strategy and makes recommendation for improvement in closing gaps in care, to achieve NCQA HEDIS metric benchmarks
Helps to develop strategy and improve Auto Assignment Algorithm (AAA) band ranking performance
Helps to develop and improve CAHPS Member Satisfaction Survey scores/outcomes
In partnership with functional areas and business owners, works to improve Michigan specific Apple Consumer Guide scores
Helps to develop and implement improvement strategy for NCQA Star rating
Works to help facilitate and improve Quality Withhold metrics, as defined by the State on an annual frequency
Works with Dental Plan Vendors to improve Dental Program Strategy and performance outcomes to align with State and National benchmarks
Develops and implements the infrastructure of the QM program and patient safety strategy and PQOC analysis/issues
Directs/provides enhancements to business processes, policies, and infrastructure to improve operational efficiency across the organization
Influences department business owners and leaders to reach solutions to meet the needs of stakeholders, both internal and external
Provides comprehensive analysis of state PIP's, barriers, and opportunities and presents results of improvement efforts and ongoing performance measures to plan management

Requirements:

5+ years of progressive experience in a regulatory environment and/or quality management
At least 5+ years of managed care experience
Bachelor's degree or equivalent managed care experience

Nice to have:

Project Management skills and proficiency
Proficiency with Microsoft Office Suite applications and other common computer and office software
PMP Certification
Lean Six Sigma (Green/Black Belt)
Tableau Dashboards/Analytics
Medicare / Medicaid experience
Experience with HEDIS Metrics, CAHPS Member Satisfaction Surveys, NCQA Accreditation, Compliance Audits and/or MI State Reporting / Compliance

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 01, 2025

Expiration:
September 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Quality Project Manager