at CVS Health in Springfield, Illinois, United States
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand – with heart at its center – our purpose sends a personal message that how we deliver our services is just as important as what we deliver. 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.
The Aetna business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health’s unrivaled presence in local communities and their pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.
Aetna is recruiting for a Chief Quality Lead to i mplement strategy for health care product quality management to meet consumer expectations and organizational quality standards. This leader will be responsible for the design and implementation of Pay for Performance programs to achieve the state 90th percentile required in the contract, $4 Billion all quality dollars at risk auto-assignment, and member choice. The Quality Improvement Plans are cross-functional for CM, VBD and provider engagement for 6 plans. This role is responsible for leading and designing the HEDIS IL strategy (hybrid) which involves three products – MMP, Duals, LTSS on top of the Medicaid Hybrid product.
Position SummaryYou’ll make an impact by:
+ Establishing policies and programs to measure, monitor, and improve health care quality throughout the organization. Leading area processes for the organization’s healthcare quality area, and ensures methods align with the overall business strategy.
+ Ensures compliance of health care quality management programs with regulatory and accreditation requirements and provide executive leadership and develop enterprise-wide, results oriented quality strategy to drive improvements at the national, regional and market level.
+ Overall coordination, implementation, and monitoring of activities to yield quality driven, innovative, compliant, efficient, and cost-effective results.
+ Formulates organizational policies, goals, and objectives based on best practices in the field.
+ Develops strategic relationships with internal and external leaders to support quality initiatives. Partners with executive leadership to define our strategy and success criteria for the future.
+ Advises on legislative changes that have the potential to impact quality and care management practices and standards.
+ Develops methodology to improve quality performance results, service effectiveness, and system efficiency.
+ Delivers resolutions for gaps in processes and organizational challenges.
+ Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
+ Provides clarity around the vision, market opportunity, value, how to win in the market, metrics, objectives, assumptions, dependencies, constraints, and how the vision delivers results for the organization.
+ Translates strategy into defined tactics, programs / projects, priorities, and timelines and ensures alignment and attainment of both the regions and the enterprises strategic plans to turn strategy into reality.
+ Oversees definition development and implementation of metrics to report and monitor progress against goals and ensures plan of record supports strategy milestone deliverables.
+ Monitors, measures, and communicates delivery against business strategic plan and the quality of outcomes.
+ Provides coaching and mentoring to other leaders in the organization on strategic thinking and on projects that deliver high return and high strategic value.
+ Establishes department budget and controls department expenses.
+ Supporting CVS Health in attracting, retaining, and engaging a diverse and inclusive consumer-centric workforce that delivers on our purpose and reflects the communities in which we work, live, and serve.
The candidate will have a strong work ethic, be a self-starter, and be able to be highly productive in a dynamic, collaborative environment. This position offers broad exposure to all aspects of the company’s business, as well as significant interaction with all the business leaders. The candidate will be expected to have the following key attributes:
+ 15+ years clinical/managed care/health care industry experience.
+ Quality improvement and management experience in a managed care organization required.
+ Thorough knowledge of NCQA and/or HEDIS management.
+ Multiple years proven leadership experience setting strategic direction and influencing change that resulted in quantifiable positive outcomes.
+ Demonstrated negotiation skills.
+ Proven track record managing complex projects and or programs that resulted in cost savings.
+ Experience managing large budgets.
+ Effective and advanced organizational, decision-making, and analytical skills.
+ Ability to work Hybrid Model (in office Tuesday / Wednesday / Thursday.
+ Demonstrated a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias.
Bachelor’s degree required. Master’s degree preferred. Certified Professional in Health Quality (CPHQ) or other certification a plus.
The typical pay range for this role is:
$131,500.00 – $297,250.00
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 jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have receiv