Registered Nurse - Manager - Healthcare Quality

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Must live in Michigan Must hold a clinical license, preferably, Nursing License The Manager of Health Care Quality will support the functions of the Michigan Highly Integrated Duals Eligible (HIDE) quality program, including regulatory deliverables, HEDIS activities and reporting and other quality improvement activities. Be a collaborative partner with internal and external stakeholder to facilitate daily quality improvement (QI) functions.

Coordinate and monitor quality improvement projects from inception to closure including quality withhold performance, NCQA accreditation and contract compliance. Develop the annual quality workplan to include program activities. Support population health management and health equity activities to address inequities aimed to reduce disparities. Monitor all workplan activities to ensure state, federal and NCQA compliance. Ensure all quality policies are updated annually and in compliance with state contract. Collaborate with all internal and external stakeholders to identify, develop, and implement innovative programs and initiatives to improve outcomes. Manage medical record review and compile reports for both committee presentation and state submission. Analyze data, develop reports and present to plan committees. Adhere to NCQA standards and work with the National Quality Management Accreditation team to maintain the plan's NCQA accreditation. Support the coordination of corporate compliance and external surveys as needed. Support the project life cycle including requirements gathering, creation of project plans and schedules, manage resources, support HEDIS audit process, and facilitate project execution, deployment and closure. Active member of quality committees to drive improvement efforts. Participate in external quality review audits.