Quality Compliance - Sr Manager

CVS Health

1d•$75,400 - $165,954

About The Position

The Senior Manager, Health Care Quality Management for OhioRISE is responsible for leading and overseeing quality-related projects within the OhioRISE program, ensuring alignment with Medicaid managed care requirements and the unique needs of Ohio’s youth with complex behavioral health needs. This position drives compliance with state and federal regulations, supports continuous improvement of program processes, and fosters collaboration across agencies and providers serving OhioRISE members.

Requirements

7+ years of relevant work experience
At least 5 years of experience in quality assurance, project management, or Medicaid managed care
Demonstrated ability to manage multiple, complex projects impacting Medicaid or behavioral health populations, with measurable improvements in quality outcomes.
In-depth understanding of Medicaid rules and regulations, especially those relevant to OhioRISE, behavioral health, and youth-serving systems.
Excellent leadership, stakeholder communication, and engagement skills, especially in multidisciplinary and cross-agency environments.
Proficiency with project management and quality improvement tools and software.
Bachelor’s degree in a related field such as Public Health, Social Work, Health Administration, Quality Management, or Behavioral Health

Nice To Haves

experience with behavioral health programs
Direct experience with NCQA-accredited programs is highly preferred.
Understanding of Ohio’s system of care.
Familiarity with OhioRISE.
Familiarity with intensive behavioral health services.
Master’s degree preferred.

Responsibilities

Lead OhioRISE policy governance and lifecycle management as a primary driver of quality and compliance, ensuring policies are current, operationalized, and aligned with NCQA standards, Ohio Department of Medicaid requirements, and Aetna Medicaid expectations. This includes ownership and oversight of the Aetna policy portal and ODM policy portal, ensuring accuracy, accessibility, and timely updates.
Serve as the program lead for ongoing NCQA excellence, managing and advancing OhioRISE’s NCQA certification and readiness activities. Ensure that quality initiatives, committee work, documentation, and operational practices consistently demonstrate adherence to NCQA standards and continuous improvement expectations.
Align with teams on planning, implementation, and evaluation of OhioRISE quality improvement initiatives, ensuring each initiative is explicitly tied to policy requirements, NCQA standards, and ODM regulatory expectations.
Direct and oversee OhioRISE quality committees, including Quality Management, Utilization Management, Provider Advisory Committee, Quality Management Oversight Committee, Quality of Care Council, and related workgroups, ensuring committee structures, agendas, and outputs reinforce policy adherence and NCQA priorities.
Partner with committee members and stakeholders to identify policy gaps, NCQA risks, and quality improvement opportunities, driving action items to completion and ensuring measurable progress toward regulatory and accreditation goals.
Identify quality, policy, and accreditation risks, develop mitigation strategies, and proactively address barriers to compliance and performance, with a sustained focus on continuous improvement and member impact.