Sr. Manager, Health Outcomes Accreditation

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.

Position Summary

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 organizational excellence across health plan populations. Responsible for the design, development, implementation, and ongoing evaluation of 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. Provides support for additional accreditation and regulatory programs as organizational priorities evolve.

Primary Job Duties & Responsibilities:

1. Leads NCQA Accreditation activities including standards interpretation, readiness assessments, gap analysis, documentation review, survey preparation, corrective action planning, and ongoing accreditation maintenance. - 35%

2. Serves as the organization'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. - 20%

3. Develops and delivers accreditation strategies, executive presentations, governance reporting, and action plans in collaboration with business owners and cross-functional partners. - 15%

4. Manages multiple complex accreditation and quality improvement initiatives, ensuring milestones, deliverables, and regulatory requirements are achieved. - 15%

5. 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. - 10%

6. Supports additional accreditation, certification, quality, and regulatory initiatives as assigned, providing consultation and project leadership across business areas. - 5%

Required Qualifications

• 3-5 years as a subject matter expert on NCQA Health Outcomes Accreditation and Community-Focused Care (CFC) standards, providing interpretation, guidance, and consultation across the organization.
• 3-5 years 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.
• Evaluates organizational performance against accreditation standards and quality goals, identifying compliance risks, improvement opportunities, and actionable recommendations.
• Leads cross-functional teams, workgroups, and governance committees to support accreditation, health equity, quality improvement, and organizational performance objectives.
• Accountable for the design, development, implementation, and oversight of accreditation, quality improvement, and health equity initiatives that support organizational goals and improved health outcomes.
• Develops executive-level reports, presentations, readiness assessments, and governance materials to communicate accreditation status, risks, accomplishments, and strategic priorities.
• Directs and influences enhancements to business processes, policies, procedures, and infrastructure to improve compliance, operational effectiveness, and accreditation performance.
• Performs strategic analysis of business performance and accreditation-related data to identify trends, prioritize improvement initiatives, and support business decision-making.
• Collaborates with business owners and senior leaders to develop new or enhanced programs, products, services, and operational capabilities that support accreditation and quality objectives.
• Monitors emerging accreditation, regulatory, and health equity requirements and assesses organizational impact, recommending strategies to ensure ongoing compliance and readiness.
• Serves as a technical, professional, and business expert across multiple functions, translating accreditation requirements and business needs into actionable strategies and implementation plans.
• May manage a quality management function, including oversight of performance metrics and application of organizational policies and procedures.
• May manage other accreditation activities as the needs of the organization changes.
• Regular and reliable attendance required. Travel may be required. Performs additional duties as assigned.
• Must demonstrate a proven track record of proactive problem-solving, strong organizational skills, sharp attention to detail and ability to think and act independently.

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.
• Certified Professional in Clinical Health Equity (CPCHE), Certified Professional in Healthcare Quality (CPHQ) or equivalent quality certification.

Education

Bachelor's Degree preferred or Master's degree; equivalent work experience preferred.

Other License(s) - Certified Professional in Health Quality (CPHQ): Preferred

We support a hybrid work environment if selected and you live near a suitable work location you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.