At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
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. Responsibilities include assimilating information to proactively develop quality activities aligned with program goals and objectives; linking the quality management activities to business goals; advance business objectives by supporting and connecting diverse teams, fostering productive partner relationships, and applying deep quality expertise to help teams translate quality insights into business strategy.

Responsibilities

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

Required Qualifications

- 5+ years of progressive experience in a regulatory environment and/or quality management

· At least 5+ years of managed care experience

Preferred Qualifications

- 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

Education
· Bachelor’s degree or equivalent managed care experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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. 
 

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: 09/30/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.