Senior Health Care Quality Management Specialist (Florida-Remote)

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 The Senior Health Care Quality Management Specialist designs, implements, and maintains a comprehensive quality management strategy that meets internal business objectives and external regulatory and accreditation requirements. This role ensures successful demonstration of quality outcomes in alignment with National Committee for Quality Assurance (NCQA), state Medicaid and CHIP regulators, and contractual obligations. The position connects quality management initiatives to enterprise goals through innovation, integration, data analysis, and performance reporting. The individual actively supports the development, execution, and evaluation of Quality Management work plans, accreditation activities, and ongoing quality improvement efforts.

Key Responsibilities

• Support accreditation activities for health plan operations, health equity programs, and long term supports and services.
• Ensure compliance with quality related contractual requirements, including performance improvement projects, quality improvement analyses, and annual program evaluations.
• Measure and monitor adherence to clinical and preventive health guidelines using established benchmarks and external standards.
• Assist in the design, implementation, and evaluation of Quality Management projects and initiatives.
• Analyze quantitative and qualitative data to assess health plan performance and achieve operational targets.
• Translate analytical findings into clear, actionable business insights for leadership and stakeholders.
• Support quality committee operations, including meeting preparation, documentation, reporting, and follow up activities.
• Prepare Quality Management documents that align with regulatory guidance, accreditation standards, and internal business requirements.

Required Qualifications

• Must reside in Florida or be willing to relocate to Florida within 3 to 4 months of the start date. Relocation assistance is not provided.
• Minimum of 2 years of direct experience supporting Performance Improvement Projects (PIPs) and or accreditation activities.
• Strong analytical skills with the ability to interpret and present complex data.
• Proficiency in Microsoft Office applications, with advanced skills in Excel and PowerPoint.
• Excellent verbal and written communication skills with the ability to engage internal and external stakeholders.

Preferred Qualifications

• 4 years of experience in managed care quality or 5 years of experience in Medicaid managed care.
• 2 years of experience leading or managing NCQA accreditation activities.
• 4 years of direct experience with performance improvement projects.
• 4 years of NCQA accreditation experience.
• Medicaid managed care experience.
• Master’s degree.

Education

• Bachelor’s degree or equivalent work experience in managed care quality or a closely related field

Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $46,988.00 - $102,000.00 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. 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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 06/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.