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Position Summary

The Quality Management organization is responsible for leading the delivery of Aetna quality and compliance efforts, cross-functional reporting, and cultural transformation. This position will be managing Covered CA quality requirements across quality programs, leading the Enrollee Experience Survey (EES) Strategy for the Exchange membership, and providing outreaches/ education in focus Exchange markets to support improved health outcomes. May add additional other state responsibilities

• Lead provider education/outreach opportunities in focus Exchange markets to improve targeted population health quality and outcomes. These education sessions will engage and educate providers in understanding EES, HEDIS, improving measure results, closing gaps in care, and more.   
• Support business growth and positive external business relationships for Covered CA through contract reviews, state proposal requests, presentations, and meetings, with additional state responsibilities to be added in the future to address business needs.
• Ensure specific QIS requirements for Covered California are implemented, monitored, reported to Covered CA including but not limited to improving Hospital Safety, Maternity Care, and Quality Transformation Initiatives (QTIs).
• Manage disparity reduction plans for Covered California that includes baseline disparity identification, root cause analysis, interventions, and strategies along with implementation timeline, evaluation, and proposed improvement target. Monitor and report progress annually and establish a quality improvement plan if targets are not met.
• Partner on annual Covered CA updates to the Health Equity Program Description and Evaluation assessing the effectiveness of the Health Equity (HE)/Culturally and linguistically appropriate services (CLAS) program activities. Review, plan, and implement activities within the HE work plan to include conducting annual community and internal staff focus groups to enhance CLAS, engagement, and accountability.
• Lead the design and implementation of our EES strategy, ensuring we have actions to maximize results in our focus areas and improve survey participation.

Required Qualifications

-  Registered Nurse

- 7+ years of clinical quality work experience
- 3+ years’ experience working with Regulatory Agencies, including CA
- 5 years background in healthcare strategy and planning experience
- 5+ years provider or member outreach experience
- 1 year+ Project Management experienced
- 3 years’ experience leading strategic initiatives
- Strong communication skills
- Critical thinking skills

Preferred Qualifications

-  Registered Nurse
- 2 years experience working with Medicaid or Exchange Contract Requirements

Education

Bachelor's Degree or equivalent experience

Pay Range

The typical pay range for this role is:

$75,400.00 - $199,144.80

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 09/21/2024

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