Lead Director - Quality Management

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.

Bring your heart to CVS Health

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 a Lead Director of Quality Management, you will provide strategic leadership, oversight, and execution of quality improvement, regulatory quality programs, provider performance initiatives, accreditation activities, and population health strategies that support Kentucky Medicaid members and providers.

This role serves as the market quality leader and is responsible for driving measurable improvements in quality outcomes, member experience, health equity, provider engagement, and regulatory performance while aligning market activities with enterprise Medicaid quality objectives.

Primary Responsibilities

• Lead development and execution of the Kentucky Medicaid Quality Strategy.
• Direct quality improvement initiatives focused on regulatory, contractual, and enterprise quality objectives.
• Drive performance improvement efforts for HEDIS®, QRS, state quality metrics, value-based incentives, and market-specific performance goals.
• Provide leadership and oversight for Quality Assessment and Performance Improvement (QAPI) activities.
• Oversee regulatory quality reporting, state deliverables, and Performance Improvement Projects (PIPs).
• Ensure readiness for NCQA, EQRO, CMS, state audits, accreditation activities, and regulatory reviews.
• Partner with Market Leadership, Medical Affairs, Population Health, Care Management, Provider Relations, Network, and Operations to improve member outcomes and reduce health care disparities.
• Lead provider performance improvement strategies, including provider engagement, practice transformation, and quality interventions.
• Monitor quality performance trends and identify opportunities for improvement through data-driven analysis and targeted action plans.
• Develop and present executive-level performance reports, recommendations, and strategic updates to divisional and market leadership.
• Support implementation of enterprise initiatives related to digital quality, interoperability, value-based care, behavioral health, maternal health, preventive care, and chronic condition management.
• Provide leadership, coaching, and development for quality team members.
• Foster a culture of accountability, innovation, continuous improvement, and collaboration.

Required Qualifications

• Must reside in the state of Kentucky
• 10 years of experience in healthcare quality, managed care, population health, clinical operations, healthcare administration, or a related field.
• 7+ years of leadership experience.
• Experience leading quality improvement initiatives and performance management programs.
• Knowledge of Medicaid quality programs, regulatory requirements, and healthcare quality measurement.
• Experience working with HEDIS, NCQA, CMS, accreditation standards, and performance improvement methodologies.
• Demonstrated ability to lead cross-functional initiatives and influence leaders across multiple business areas.
• Strong analytical, communication, and executive presentation skills.

Preferred Qualifications

• Medicaid managed care experience.
• NCQA accreditation experience.
• Population Health and Health Equity expertise.
• Provider engagement and practice transformation experience.
• Experience with value-based care and provider incentive programs.
• Knowledge of interoperability, supplemental data strategies, and quality reporting modernization.
• Registered Nurse (RN) license preferred.
• Master's degree preferred.

Education

• Bachelor's degree required.
• Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or related field preferred.

Position Impact

This role is accountable for market quality performance, regulatory compliance, accreditation readiness, provider quality engagement, health equity advancement, and execution of enterprise Medicaid quality strategies. The position directly influences member outcomes, quality incentive performance, provider collaboration, regulatory success, and overall market performance.

The Kentucky Lead Director of Quality serves as the market's senior quality leader and strategic advisor for Medicaid quality performance. The role is responsible for ensuring achievement of contractual quality requirements, supporting provider performance improvement, advancing population health initiatives, reducing health disparities, strengthening quality governance, and partnering across the organization to improve clinical outcomes and financial performance tied to quality…