Description
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 colleagues who care deeply, innovate with purpose, hold themselves accountable, and prioritize safety and quality in everything they do.
Job Purpose and Summary: Accountable for leading NCQA Health Outcomes (HOA) and Community-Focused Care (CFC) Accreditation initiatives that support quality improvement, regulatory compliance, and organisational excellence across health plan populations. Responsible for designing, developing, implementing, and evaluating accreditation strategies, readiness activities, gap assessments, corrective action planning, and performance improvement initiatives. 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.
Primary Job Duties & Responsibilities:
- Leads NCQA Accreditation activities, including standards interpretation, readiness assessments, gap analysis, documentation review, survey preparation, corrective action planning, and ongoing accreditation maintenance.
- Serves as the organisation's subject matter expert for 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.
- Develops and delivers accreditation strategies, executive presentations, governance reporting, and action plans in collaboration with business owners and cross-functional partners.
- Manages multiple complex accreditation and quality improvement initiatives, ensuring milestones, deliverables, and regulatory requirements are achieved.
- Proactively builds strong business relationships with internal and external business partners, linking quality management activities to business goals and leads cross-functional teams to assist business units with quality activities.
Required Qualifications:
- 3-5 years as a subject matter expert on NCQA Health Outcomes Accreditation and Community-Focused Care (CFC) standards.
- Experience with accreditation readiness activities, including gap assessments, standards implementation, document reviews, mock surveys, corrective action planning, and ongoing compliance monitoring.
- Partners with operational, clinical, quality, compliance, population health, care management, network, member experience, and analytics teams to integrate accreditation requirements into strategic and operational business processes.
Preferred Qualifications:
- 6+ years 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.
Education: Bachelor's Degree preferred or Master's degree; equivalent work experience preferred.
Pay Range: $67,900.00 - $199,144.00
Benefits: Eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.