Quality Audits Senior Manager
About The Position
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Candidate may reside anywhere in the US Position Summary The Senior Manager, Quality Assurance and Audit is a critical leadership role responsible for the strategic oversight and execution of quality programs within the Grievance & Appeals QA organization. This role ensures operational excellence, regulatory compliance, and audit readiness across Medicare, Medicaid, and Duals lines of business. The Senior Manager leads and develops a high-performing team of Quality Analysts and serves as a subject matter expert for G&A quality standards, policies, and audit processes. This leader partners cross-functionally to drive continuous improvement, mitigate compliance risk, and deliver best-in-class quality outcomes in a highly regulated environment.
Requirements
- 7+ years of experience of quality or audit responsibility in Medicare, Medicaid, and/or Duals Grievance & Appeals, with demonstrated QA or oversight responsibility
- Proven experience leading external regulatory audits and formal quality reviews
- Deep knowledge of integrated G&A regulatory requirements
- Experience leading and developing remote teams
- Strong training, mentoring, and coaching experience (virtual and/or in-person)
- Advanced communication, analytical, and supervision skills
Nice To Haves
- Experience with state and federal regulatory requirements
- Strong deductive reasoning and advanced analytical skills
- Proficiency with Microsoft Office Suite and Quickbase
- Demonstrated problem-solving ability in complex, regulated environments
- Collaborative, team-oriented leadership style
Responsibilities
- Design, implement, and continuously improve internal QA processes to deliver best-in-class audit performance and compliance outcomes
- Lead oversight of case and letter quality reviews, ensuring accuracy, timeliness, and adherence to regulatory requirements
- Conduct regular quality audits and case reviews; identify trends, risks, and improvement opportunities
- Lead internal and external audit preparation, presentations, and responses, including state and federal regulatory audits
- Serve as a primary quality and compliance liaison during external reviews and examinations
- Provide expert input for policy updates, system enhancements, and regulatory interpretation
- Lead, mentor, and develop a team of Quality Analysts in a remote environment
- Track, monitor, and manage staff quality performance, providing ongoing feedback, coaching, and corrective action plans as needed
- Ensure completion of required training, continuing education, and skill development for QA staff
- Perform daily monitoring of inventory to support timeliness standards and workload balancing
- Collaborate on the development and maintenance of QA desktops, job aids, and training materials
- Partner with operational, compliance, and leadership teams to support enterprise quality goals
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
