Accountable for health care quality projects and initiatives through direction setting and leadership. Assimilates information to proactively develop quality activities aligned with company strategies and values. Links the quality management activities to business goals. Proactively builds strong teams and business relationships, both internally and externally. Serves as a resource and subject matter expert (SME) on aspects of the quality program to develop and influence business strategies.
Makes business decisions based on the results of research and data analysis.
Has responsibility for decision making regarding the design, development, and implementation strategy of quality improvement projects, and initiatives.
May manage a QM functional department including development and oversight of performance metrics and application of HR policies and procedures.
Forms and leads cross functional teams to assist business units in integrating quality into their strategic and operational plans. Evaluates and prioritizes recommendations for quality improvement to senior management and/or customers.
Partners with sales and marketing across all segments in their efforts to acquire and retain customers (e.g. responding to RFPs), quality presentations, request for measurement information.
Develops and implements the infrastructure of the QM program and Patient Safety strategy.
Develops, implements, and evaluates the organization's policies and procedures to meet business needs.
Directs/provides enhancements to business processes, policies and infrastructure to improve operational efficiency across the organization.
Influences department business owners and leaders to reach solutions to meet the needs of Plan Sponsors, regulators and other customers while meeting departmental objectives.
Performs strategic analysis of business performance data to address Plan Sponsor needs.
In partnership with business owners, supports design /development of new or enhanced products and services. Translates knowledge of subject and business needs into clear strategic business plans.
Serves as a technical, professional and/or business expert that may cross multiple business functions.
6+ years progressive experience in operational quality management roles in the healthcare industry, regulatory environment and quality management required.
Managed Care experience required. HEDIS experience required CAHPS experience preferred Demonstrated leadership ability preferred RN licensure required Bachelor's degree, Nursing degree, or other comparable healthcare experience.
Additional Job Information
Understanding of trends and constituency expectations.
Bachelor's degree or equivalent experience
Percent of Travel Required
25 - 50%
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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