Quality Assurance Manager

1 month ago

Austin, Texas, United States CVS Health Full time
Job Summary

CVS Health is seeking a highly skilled Quality Assurance Manager to join our team. As a key member of our quality management team, you will be responsible for ensuring the highest level of quality in our healthcare services.

Key Responsibilities
  • Act as an advocate for quality and effectiveness of work processes, directly impacting customer satisfaction and operational efficiency.
  • Consult and/or work cross-functionally to influence and promote change to continually deliver quality service to internal and external customers.
  • Conduct complex quality management, procedural documentation, and/or special analysis audits and projects.
  • Manage contractually required audits involving significant financial value and risk.
  • Oversee multiple concurrent projects, including planning, execution, evaluation, and formulating corrective actions.
  • Serve as a subject matter expert in Quality Management, auditing practices, external audits, and internal audits.
  • Lead the planning, organization, and facilitation of multiple, concurrent projects of high complexity.
  • Draft audit issues and reports for each assigned project, effectively communicating the purpose and conclusions in a manner suitable for senior leadership.
  • Manage project resource needs, identify and communicate resource/administrative gaps, and work with department management to secure necessary resources to meet project objectives.
  • Participate in department-wide activities, such as training and staff development, as well as management presentations to other Aetna/CVS Health areas.
  • Provide oversight in the completion of process improvements for each project, testing that interventions/solutions were effective in remediating and improving the quality of work for that which was in scope for the project.
  • Work with business leadership and their staff as necessary to review project findings, draft solutions, track corrective action plans, and track the installation of improvement solutions.
Requirements
  • 3 years of Risk Adjustment experience.
  • Preferably have an active RN, NP, or PA License.
  • Active certified coder certification through AHIMA or AAPC required (CRC, CPC, CCS - P). CCA, CPC-A are not accepted.
  • At least one year of experience as a certified coder is required.
  • Experience with Medicare Advantage products.
  • Strong clinical knowledge related to chronic illness diagnosis, treatment, and management.
  • Reliability and a commitment to meeting tight deadlines.
  • Personal discipline to work remotely without direct supervision.
Preferred Qualifications
  • Significant project management experience within Medicare Advantage and ACA or related field.
  • Ideal experience with vendors that provide supplemental benefits. Audit or related business experience with insurance, demonstrating high proficiency in the competencies noted.
Education
  • Bachelor's Degree or relevant experience in lieu of degree.
  • Preferred to have a degree in Public Health, Health Care Informatics, Risk Management, Insurance, or related field of study. Advanced degree preferred.
Pay Range

The typical pay range for this role is $54, $145,860.00. 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ('PTO') or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time, and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | CVS Health. We anticipate the application window for this opening will close on: 11/02/2024. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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