Sr. Manager, Quality Management

Job DescriptionThe Sr. Manager Health Care Quality Management will manage the functions of the Michigan duals Medicare-Medicaid quality program, including regulatory deliverables, HEDIS activities and reporting and other quality improvement activities. Providing support to staff and communicate with departments across the health plan to facilitate daily quality improvement (QI) functions. Coordinate and monitor quality improvement and organizational projects from inception to closure including quality withhold performance and Healthcare Effectiveness Data and Information Set (HEDIS) preparation.Provide functional and technical knowledge for HEDIS across all plan departmental staff and deliver educational sessions to internal staff and external constituents as needed.Coordinate Work Plan, team and resources for all QI activities.Monitor all workplan activities to ensure both state and federal compliance. Write the annual quality program trilogy documents (program description, workplan, program evaluation) and manage activities throughout the year. Ensure all quality policies are updated annually and in compliance with state contract. Collaborate with all internal and external stakeholders in identifying, developing, and implementing innovative programs and initiatives to improve outcomesAnalyze data, develop reports and present to plan committees.Design, run, and manage the data review process to ensure accuracy and integrity of data reports to meet regulatory and operational requirements.Coordinate and implement interventions to increase HEDIS, CAHPS, improvement projects and designated health measures for the Plan.Adhere to NCQA standards and work with National Quality Management Accreditation team to maintain the plan's NCQA accreditation.Support the coordination of corporate compliance and external surveys as needed.Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure.Participate in vendor oversight meetings with contracted vendors.Coordinate all data pulls and ongoing data management for HEDIS and QI project management databases for identified QI projects with department staff and corporate contacts. Evaluate sources for alternative data capture; assess ongoing methodology and results.Required Qualifications3+ years of quality improvement experience. Experience managing HEDIS and CAHPS activities.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 QualificationsKnowledge of Medicare-Medicaid (MMP) product.EducationBachelor's degree in health related field.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