Healthcare Quality Project Management Manager

Job DescriptionThis role is work at home with requirement to reside in the state of Virginia.Schedule: Standard business hours Monday - FridayThe Manager, Healthcare Quality Project Management coordinates cross-functional activities throughout the Health Plan to monitor and track EPSDT services provided to Medicaid members. The ideal candidate will facilitate collaborative partnerships with various internal and external stakeholders to meet NCQA standards and state requirements as they align with organizational and Health Plan goals of maintaining accreditation and sustaining healthy outcomes. Additionally, the candidate will possess the knowledge of how population health is integrated throughout the Plan and will support program development. The role also involves a thorough knowledge project managing performance improvement projects to increase healthy outcomes. Responsibilities include generating monthly and quarterly EPSDT compliance reports, analyzing data to identify trends and patterns in gaps in care, collaborating with various departments to streamline processes related to performance improvement, conducting ongoing qualitative and quantitative analyses to monitor, track, and trend EPSDT compliance/non-compliance, managing and overseeing state mandated performance improvement projects to ensure stakeholders and business owners carry out assigned tasks and activities and creating and identifying workgroups to address areas for opportunities to close gaps in careRequired Qualifications One of the following is required: RN, LPN, or a behavioral health license (LCSW, LPC, LSW, LMFT, etc) 3+ years of project management experience 3+ years of clinical experience required 1+ years of HEDIS experience 1+ year of experience analyzing and interpreting dataCOVID 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 Qualifications Full understanding of NCQA accreditation and standards Previous claims systems experience Previous EMR and/or HIM experience Knowledge and understanding of EPSDT services Managed care experience preferred Proficiency in all Microsoft Office Suite, especially Microsoft ExcelEducationAssociates degree preferredBusiness 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: 2026-03-07