Quality Management Lead Director

CVS Health•Work At Home-Louisiana, LA

2d•$100,000 - $231,540

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 must reside in Louisiana Business Overview Aetna Better Health of Louisiana, a CVS Health company, is committed to improving the health and wellness of Medicaid members through innovative, high-quality care delivery. We partner with providers, community organizations, and the Louisiana Department of Health (LDH) to advance clinical outcomes, health equity, and member experience across the state. Position Summary The Lead Director, Healthcare Quality Management is responsible for the overall leadership, execution, and continuous improvement of the Louisiana Quality Assessment and Performance Improvement (QAPI) program. This role provides full accountability for quality performance, regulatory compliance, and strategic execution across all quality domains, including HEDIS, P4P/withholds, accreditation, quality of care, and member experience. The Lead Director serves as a key member of the market leadership team and as the primary liaison to LDH for quality-related performance and compliance. The role also ensures integration of quality strategy across clinical operations, provider engagement, population health, and value-based programs to drive measurable improvements in outcomes and RFP readiness. This aligns with expectations that the Quality Director leads QAPI, CQI, and accreditation while improving outcomes for Medicaid populations and working closely with state regulators.

Requirements

10+ years of healthcare experience
5–7+ years in managed care quality leadership
Demonstrated success leading HEDIS, accreditation, and quality performance programs
Strong knowledge of Medicaid regulatory requirements and quality frameworks
Proven ability to lead cross-functional teams and influence senior stakeholders
Excellent communication, executive presence, and strategic thinking skills
RN or clinical licensure; CPHQ or related certification
Bachelor’s degree required or equivalent work experience

Nice To Haves

Experience in Louisiana Medicaid or similar markets
Experience with LTSS, behavioral health integration, and SDoH initiatives
Background in value-based care and provider performance management
Master’s degree preferred

Responsibilities

Serve as the “voice of Quality” for the Louisiana market, leading all quality strategy and execution.
Own end-to-end performance for: HEDIS and hybrid measure performance, P4P / withhold maximization, CAHPS and member experience, Quality of Care and clinical outcomes.
Develop and execute market-specific strategies aligned to enterprise priorities and Measures That Matter Most (MTMM).
Lead and oversee the Louisiana QAPI and Continuous Quality Improvement (CQI) programs in alignment with: LDH contract requirements, State and federal regulations, NCQA accreditation standards.
Ensure readiness for: NCQA surveys, EQRO audits, State audits and RFP evaluations.
Maintain documentation, policies, and reporting consistent with regulatory requirements.
Serve as a key member of market leadership and required personnel for LDH engagement.
Act as primary Quality contact with: Louisiana Department of Health (LDH), External regulators and auditors, Provider partners and delegates.
Lead quality committees and governance structures, ensuring executive oversight of performance and improvement actions.
Provide clinical oversight for: Quality of Care investigations, Performance improvement projects (PIPs), Preventive health and population health initiatives.
Integrate behavioral health, SDoH, and health equity strategies into quality improvement efforts—critical for Louisiana Medicaid populations.
Direct HEDIS and quality reporting, including: Data collection and validation, Measure performance monitoring, Gap identification and closure strategies.
Translate data into actionable insights and drive intervention strategies.
Partner with informatics, provider engagement, and care management to ensure execution.
Lead provider performance strategy, including: Value-Based Contracting (VBC) quality alignment, Provider education and engagement, Practice transformation initiatives.
Collaborate cross-functionally to embed quality into operational workflows and provider networks.
Maintain full accountability for quality-related financial performance, including: Withholds and incentive programs, Quality-related cost management.
Manage budgets and resource allocation while meeting operational goals.
Lead, develop, and mentor a multidisciplinary quality team.
Drive a culture of accountability, performance, and continuous improvement.
Build leadership bench strength aligned with enterprise talent strategy.