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CVS Health Manager Health Care Quality Management in WORK FROM HOME, Ohio

Job Description

This position will be working from home anywhere in the continental US.- Accountable for Commercial and Medicaid NCQA Accreditation quality projects and initiatives through design, development, and implementation. Assimilates information to proactively develop quality activities aligned with company strategies and values. Links quality management activities to business goals. Proactively builds strong business relationships with internal and external business partners. Serves as subject matter expert on all aspects of the quality program.Makes business decisions based on results of research and data analysis. Proven experience as a subject matter expert on NCQA accreditation standards, analysis, Case Management/ Utilization Management file reviews, and supporting quality functions. Leads cross functional teams to assist business units with quality activities. Manages, directs, and plans multiple complex accreditation projects through completion of business objectives. Designs and develops templates, materials, and guidance documentation. Influences change or enhancements to policies and processes to improve quality. Develops and participates in presentation and consulting to business partners on clinical accreditation requirements around Population Health, Care Management, Utilization Management, Pharmacy to achieve results.

Required Qualifications

RN License3+ years managing NCQA accreditation activities through multiple cycles. Progressive experience in operational quality management roles in the healthcare industry.3+ years Supervisory ExperienceExcellent verbal and written communication skills Demonstrated ability to effectively coordinate multiple projects simultaneously

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Experience with Commercial and Medicare health plansExperience with Pharmacy formularies a plusFull time work at home any location across US


Bachelors Degree or comparable healthcare experience

Business Overview

At 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.