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.

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