Lead Director - Quality Management

CVS Health•Work At Home-Kentucky, KY

3d•$100,000 - $231,540

About The Position

The Lead Director of Quality Management provides strategic leadership, oversight, and execution of quality improvement, regulatory quality programs, provider performance initiatives, accreditation activities, and population health strategies supporting Kentucky Medicaid members and providers. As the market’s senior quality leader and strategic advisor, this role drives measurable improvements in quality outcomes, member experience, health equity, provider engagement, regulatory performance, and financial performance tied to quality results, while aligning market activities with enterprise Medicaid quality objectives. The position is accountable for market quality performance, regulatory compliance, accreditation readiness, provider quality engagement, health equity advancement, and execution of enterprise Medicaid quality strategies. It supports achievement of contractual quality requirements, provider performance improvement, population health initiatives, reduction of health disparities, stronger quality governance, and cross-organizational collaboration to improve clinical outcomes. The role also provides leadership, coaching, and development for quality team members. The role must be based in Kentucky. A bachelor’s degree is required; a relevant master’s degree and an RN license are preferred. The stated base pay range is $100,000–$231,540. The position is eligible for a CVS Health bonus, commission, or short-term incentive program and an equity award target. This is a full-time position with benefits that include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

Must reside in the state of Kentucky.
10 years of experience in healthcare quality, managed care, population health, clinical operations, healthcare administration, or a related field.
7 or more years of leadership experience.
Experience leading quality improvement initiatives and performance management programs.
Knowledge of Medicaid quality programs, regulatory requirements, and healthcare quality measurement.
Experience working with HEDIS, NCQA, CMS, accreditation standards, and performance improvement methodologies.
Demonstrated ability to lead cross-functional initiatives and influence leaders across multiple business areas.
Strong analytical, communication, and executive presentation skills.
Bachelor’s degree required.

Nice To Haves

Medicaid managed care experience.
NCQA accreditation experience.
Population health and health equity expertise.
Provider engagement and practice transformation experience.
Experience with value-based care and provider incentive programs.
Knowledge of interoperability, supplemental data strategies, and quality reporting modernization.
Registered Nurse (RN) license.
Master’s degree in Nursing, Healthcare Administration, Public Health, Business Administration, or a related field.

Responsibilities

Lead development and execution of the Kentucky Medicaid Quality Strategy.
Direct quality improvement initiatives focused on regulatory, contractual, and enterprise quality objectives.
Drive performance improvement for HEDIS®, QRS, state quality metrics, value-based incentives, and market-specific performance goals.
Provide leadership and oversight for Quality Assessment and Performance Improvement (QAPI) activities.
Oversee regulatory quality reporting, state deliverables, and Performance Improvement Projects (PIPs).
Ensure readiness for NCQA, EQRO, CMS, state audits, accreditation activities, and regulatory reviews.
Partner with Market Leadership, Medical Affairs, Population Health, Care Management, Provider Relations, Network, and Operations to improve member outcomes and reduce health care disparities.
Lead provider performance improvement strategies, including provider engagement, practice transformation, and quality interventions.
Monitor quality performance trends and identify improvement opportunities through data-driven analysis and targeted action plans.
Develop and present executive-level performance reports, recommendations, and strategic updates to divisional and market leadership.
Support enterprise initiatives related to digital quality, interoperability, value-based care, behavioral health, maternal health, preventive care, and chronic condition management.
Provide leadership, coaching, and development for quality team members.
Foster accountability, innovation, continuous improvement, and collaboration.