Lead Director Quality Management

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Business Overview:

Aetna Better Health of Oklahoma, a CVS Health company, embodies the vision to be a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way!

Position Summary:

Qualified candidates must reside in Oklahoma. The Quality Director is responsible for the operation of the Contractor’s Quality Assessment and Performance Improvement (QAPI) program in accordance with the requirements of Section 1.11: “Quality” of this Contract. The Quality Director will be responsible for developing and managing the Contractor’s portfolio of improvement projects and will work collaboratively with all Contractor’s and OHCA to improve population health outcomes, including addressing health equity and Social Determinants of Health.

The Quality Director acts as an advocate for, and supports, the business by serving as a quality champion through measuring and monitoring the quality and effectiveness of the care and service provided to our members. Leads and manages all aspects of quality programs and projects that enable Aetna to measure, monitor, and improve the quality of the care and service provided to its members. Consults and/or works cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers. Responsible for coordinating, leading, and managing multiple functional areas/units including full accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member satisfaction. As a member of the Key Personnel team for Aetna Better Health of Oklahoma, the candidate will need to travel to required meetings throughout the state.

Fundamental Components:

• Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards.

• Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc.

• In conjunction with key business leaders, responsible for directing the activities of quality committees.

• Provides direction setting and leadership, with accountability for quality program(s), specialized audits, special reviews, projects and initiatives. Manage complex projects, people, and business priorities to achieve member satisfaction.

• Develops and implements quality improvement activities nationally and/or within an assigned region.

• Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results.

• Influences all stakeholders to support key quality projects/programs to ensure positive solutions that deliver results. Consults with internal/external customers on solutions that impact Quality.

• Controls expenses while meeting operational, functional and service requirements.

• Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews and disciplinary actions.

•Ability to interact with a variety of external and internal audiences including senior management.

Required Qualifications :

• 5 to 7 years’ clinical and/or managed care experience in the healthcare industry and quality management.

• Previous experience that reflects a proven track record or proficiency in the competencies noted.

• Exceptional verbal/written/presentation communication skills.

• Ability to work in a fast-paced environment.

• Demonstrated ability to plan, organize, and execute multiple functional business objectives.

• Previous experience leading and managing staff.

• 3 years demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)

• Must be willing and able to travel in-state up to 25%; with possibility of out of state travel for meetings, up to 10%. Mileage and travel expense is reimbursed per our company expense reimbursement policy.

Preferred Qualifications :

Oklahoma residency preferred

Oklahoma-licensed registered nurse preferred OR be certified as a Certified Professional in Health Care Quality by the National Association for Healthcare Quality (NAHQ), Certified Quality Improvement Associate by the American Society for Quality, or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment.

A minimum of two years experience in a senior QI role in child/adolescent behavioral health managed care is required.

Master’s degree preferred

Pay Range

The typical pay range for this role is:

$100,000.00 – $231,540.00

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.

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 (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/12/2024

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.