Manager Health Care Quality, Project Management

Job DescriptionThe Manager Health Care Quality, Project Management leads cross-functional activities throughout the health plan to address HEDIS performance improvement and ensure effective implementation of these activities to gain positive outcomes while adhering to state contractual requirements. This person will facilitate collaborative partnerships with different departments to execute HEDIS-focused programs and monitor those programs to ensure they align with Health Plan goals. In addition, this person will have knowledge of how population health is integrated throughout the plan and will support program creation. Most importantly, the role will involve a thorough knowledge of Pay for Quality program administration including pay for performance and pay for reporting. tAccountable for HEDIS projects and initiatives through direction setting and leadership including external quality review audit activities.tInterpret and communicate the NCQA HEDIS technical specifications for program design and administration.tCollaborates with business leads to identify variances and areas for improvements and implements project plans to ensure resolution and compliance to state, federal and NCQA standardstFacilitate annual, quarterly, or ad-hoc audit activities related to HEDIS.tConduct monthly qualitative and quantitative analyses, assuring business owners are taking-action on their opportunities for improvementtTrains and onboards staff and business leads on HEDIS specifications, and ongoing to ensure their continuing understanding of the specificationsRequired Qualificationst3 years experience in a project management role.3 years experience working in the Health Care Insurance Industry.t3 years managerial experience hiring, coaching, developing performance improvement plans and mentoring junior staff tMust have full understanding of HEDIS technical specifications.tMust be proficient in all Microsoft office Suite, especially Microsoft Excel.tMust be analytical and able to interpret datatMust be articulate and able to communicate to multiple internal and external stakeholders.tMust have experience in leading an organization through accreditationtMust be a proficient writer an possess an innate ability to communicate effectively written and orally.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationstBachelor's of Science degree in Nursing and/or related Health Care field.EducationBachelor's degree or equivalent years experience in Health Care.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15