Sr. Manager, Health Outcomes Accreditation

CVS Health • Washington, NV

7d • $67,900 - $199,144 • Hybrid

About The Position

CVS Health is hiring a Sr. Manager, Health Outcomes Accreditation to lead NCQA Health Outcomes (HOA) and Community-Focused Care (CFC) Accreditation initiatives that support quality improvement, regulatory compliance, and organizational excellence across health plan populations. The role is accountable for designing, developing, implementing, and evaluating accreditation strategies, readiness activities, gap assessments, corrective action plans, and performance improvement initiatives. It serves as a subject matter expert on NCQA Accreditation and Health Outcomes standards, partnering with business owners and operational leaders to ensure compliance, promote equitable health outcomes, and achieve successful accreditation results. The position also supports additional accreditation and regulatory programs as organizational priorities evolve.

The manager leads accreditation work from standards interpretation and readiness assessment through documentation review, survey preparation, corrective action planning, and ongoing maintenance. The role develops strategies, executive presentations, governance reporting, and action plans; manages complex accreditation and quality improvement initiatives; and builds internal and external partnerships to connect quality management activities with business goals. Additional accreditation, certification, quality, and regulatory initiatives may be assigned.

The position requires regular and reliable attendance; travel may be required. The role supports a hybrid work environment. Hires in applicable populations who live near a suitable work location are expected to work onsite three days per week under the hybrid work policy.

Requirements

• 3–5 years of experience as a subject matter expert on NCQA Health Outcomes Accreditation and Community-Focused Care (CFC) standards, providing interpretation, guidance, and consultation across an organization.
• 3–5 years of accreditation readiness experience, including gap assessments, standards implementation, document reviews, mock surveys, corrective action planning, and ongoing compliance monitoring.
• Demonstrated ability to partner with operational, clinical, quality, compliance, population health, care management, network, member experience, and analytics teams.
• Experience evaluating organizational performance against accreditation standards and quality goals, identifying risks and improvement opportunities, and developing actionable recommendations.
• Experience leading cross-functional teams, workgroups, and governance committees.
• Ability to design, develop, implement, and oversee accreditation, quality improvement, and health equity initiatives.
• Ability to develop executive-level reports, presentations, readiness assessments, and governance materials.
• Ability to direct and influence improvements to business processes, policies, procedures, and infrastructure.
• Experience analyzing business performance and accreditation-related data to identify trends and support business decisions.
• Ability to collaborate with business owners and senior leaders on programs, products, services, and operational capabilities.
• Ability to monitor emerging accreditation, regulatory, and health equity requirements and assess their organizational impact.
• Strong technical, professional, and business expertise across functions, including the ability to translate requirements and business needs into actionable strategies and plans.
• Proven track record of proactive problem-solving, strong organizational skills, sharp attention to detail, and ability to think and act independently.
• Regular and reliable attendance is required; travel may be required.
• Bachelor's degree preferred or master's degree; equivalent work experience preferred.

Nice To Haves

• 6+ years of progressive experience in operational quality management roles in the healthcare industry, regulatory environment, NCQA accreditation, health equity, and/or quality management.
• Direct experience with NCQA Health Equity-related standards or related health equity initiatives.
• Experience supporting NCQA Accreditation or other accreditation, certification, regulatory, or quality improvement programs.
• Certified Professional in Clinical Health Equity (CPCHE), Certified Professional in Healthcare Quality (CPHQ), or equivalent quality certification.
• Certified Professional in Health Quality (CPHQ) certification.
• Bachelor's degree or master's degree; equivalent work experience is also preferred.

Responsibilities

• Lead NCQA Accreditation activities, including standards interpretation, readiness assessments, gap analysis, documentation review, survey preparation, corrective action planning, and ongoing accreditation maintenance.
• Serve as the organization's subject matter expert on NCQA Health Outcomes and Community-Focused Care Accreditation requirements and emerging health equity standards, partnering with operational teams to integrate equitable care practices and improve outcomes.
• Develop accreditation strategies, executive presentations, governance reporting, and action plans with business owners and cross-functional partners.
• Manage multiple complex accreditation and quality improvement initiatives, ensuring milestones, deliverables, and regulatory requirements are achieved.
• Build strong relationships with internal and external business partners, link quality management activities to business goals, and lead cross-functional teams supporting business-unit quality activities.
• Support additional accreditation, certification, quality, and regulatory initiatives, providing consultation and project leadership across business areas.
• Partner with operational, clinical, quality, compliance, population health, care management, network, member experience, and analytics teams to integrate accreditation requirements into strategic and operational processes.
• Evaluate organizational performance against accreditation standards and quality goals, identify compliance risks and improvement opportunities, and recommend actionable improvements.
• Lead cross-functional teams, workgroups, and governance committees supporting accreditation, health equity, quality improvement, and organizational performance objectives.
• Design, develop, implement, and oversee accreditation, quality improvement, and health equity initiatives that support organizational goals and improved health outcomes.
• Develop executive-level reports, presentations, readiness assessments, and governance materials communicating accreditation status, risks, accomplishments, and strategic priorities.
• Direct and influence enhancements to business processes, policies, procedures, and infrastructure to improve compliance, operational effectiveness, and accreditation performance.
• Analyze business performance and accreditation-related data to identify trends, prioritize improvement initiatives, and support business decisions.
• Collaborate with business owners and senior leaders to develop new or enhanced programs, products, services, and operational capabilities supporting accreditation and quality objectives.
• Monitor emerging accreditation, regulatory, and health equity requirements, assess organizational impact, and recommend strategies for ongoing compliance and readiness.
• Translate accreditation requirements and business needs into actionable strategies and implementation plans across multiple functions.
• May manage a quality management function, including oversight of performance metrics and application of organizational policies and procedures.
• May manage other accreditation activities as organizational needs change.
• Perform additional duties as assigned; maintain regular and reliable attendance. Travel may be required.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being, based on eligibility
• Eligibility for a CVS Health bonus, commission, or short-term incentive program
• Equity award program

What This Job Offers

• Job Type: Full-time
• Career Level: Manager