We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
May reside anywhere in the US
Position Summary
Plans, monitors, and manages internal projects from initiation through timely completion to meet business objectives and increase performance. Works with internal staff across multiple departments to identify data sources, processes and activities required to meet state regulatory compliance requirements or meet the objectives of the Quality Management (QM) program avoiding financial penalties. Using innovation, integration and information, links the quality management activities to business goals.
Key Responsibilities:
-Serves as the Quality Management Project leader to oversee all aspects of quality project implementation including budget development and supervision of team participants.
-Prioritizes and makes recommendations for the design, development, and implementation strategy of quality improvement projects, and initiatives.
-Designs the data collection methodology, metrics, and data elements needed to measure outcomes of QI projects.
-Develops documentation templates and systems to support QM projects and initiatives.
-Updates and monitors multiple workplans for timely and accurate State submission.
-Forms and leads cross functional workgroups to design and implement QI initiatives.
-Translates and delivers business information to internal and external constituents via formal presentations with data visualization tools and/or written communications.
-Creates a continuous improvement plan for the project to enhance delivery processes and outcomes.
-Drives performance to meet established goals (e.g., CAHPS and other member satisfaction surveys, Lead Screening activities, Community Focused Care Accreditation). Oversees clinical documentation audits (e.g., Community-Based Palliative Care and Managed Long Term Supports and Services HEDIS hybrid project).
-Educates and consults with unit business managers on quality improvement methods (e.g., workflow, data analysis, metrics).
-Educates members and providers on relative QI initiatives to increase clinical performance).
Mentors internal QM staff regarding quality related programs, workplans and evaluation activities.
Actively seeks opportunities for process improvement resulting in efficient and effective work streams.
Manages complex relationships with both internal and external constituents (e.g., providers, internal growth partners, State agency liaisons).
Attend and lead virtual meetings with the State of NJ and other MCOs related to Lead Screening initiatives.
Required Qualifications
7-10 years of relevant managed care experience
5 to 7 years quality and/or care management experience
Exceptional verbal/written/presentation communication skills
Ability to analyze and manage large amounts of data
Demonstrated ability to plan, organize, and execute multiple projects with overlapping deliverables
Proficient in workplace applications and collaboration tools (e.g., Microsoft 365, cloud-based document management, virtual communication/collaboration, and project platforms) with the ability to leverage tools to optimize work processes
Preferred Qualifications
Attention to detail, accuracy and overall quality of reports
Adept at problem solving and decision- making skills
Strong collaboration and teamwork skills
Adaptability and Time Management skills including, but not limited to:
Strong organizational skills
Motivational interviewing skills and positive attitude
Self-motivated and leadership qualities
Project Management Certification
NJ residence
Master’s preferred
Education
Bachelor's degree preferred/specialized training/relevant professional qualification.
Pay Range
The typical pay range for this role is:
$67,900.00 - $182,549.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 03/22/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.