As the Government Quality Programs Director, you will provide leadership to multiple levels of colleagues and professional staff to develop the strategic objectives, standards and methodologies to maintain high quality ratings performance; as well as develop departmental budget to allocate resources to identified priority organizational initiatives. You will be accountable for the performance and results of the Medicare, Medicaid and Exchange quality programs for Silverscript and Caremark clients across the diverse set of quality measure disciplines. You will partner with and influence a wide set of internal and external partners at all levels of leadership, including Operational business owners, Account Managers, Product Management, and key client organizations, to drive and track initiatives focused on improving or maintaining Quality Ratings. You will need to be adept at flexing approach and communication style to fit audience.
You will also lead multiple teams of professional employees to diagnose and resolve complex business challenges that will require collaboration with diverse, cross-functional teams. You will deliver recommendations regarding organizational remediation in operational and clinical areas to improve the overall Star ratings performance. You will have a significant impact on the quality of your team’s work and the organization’s ability to achieve government performance goals.
As the Government Quality Programs Director, you will apply your understanding of the industry, the quality programs and the CVS Health organization to serve as an expert both internally and externally. This position will require an ability to develop comprehensive understanding of concepts, theories and principles as it pertains to government quality programs and broader knowledge of other disciplines that impact quality measures. In this capacity, you will oversee a team that provides consultative support services to Caremark's Sales and Account Services division and our clients regarding Quality Programs performance, regulatory changes and on-going improvement initiatives. You will establish the proactive advocacy agenda to influence evolution of quality programs, oversee the review of new requirements as published by CMS and PQA (Pharmacy Quality Alliance) and manage interpretation and communication of the required changes throughout the cross-functional business units impacted by the CMS mandated changes.
You will also be responsible for, and measured against, the following primary objectives:
- Quality Performance Governance and Accountability - Establish organizational alignment and accountability to achieve > 4 Star Performance for Silverscript; increase Medicare Clients achieving 4+ Stars to 80% of lives under management and improve Medicaid and Exchange Quality results by 5% through increased adoption of products/services and best practices
- Performance Reporting/Monitoring - Ensure that the organization has timely, accurate visibility into Stars performance for Silverscript and our clients ; and that appropriate action is taken to address insights into performance risks
- P&L Management - Lead oversight and management of Stars Initiative Budget (~$15M) to ensure investments generate maximum impact on Stars performance and that actual spend is within 2% of forecast
- Analytics – Lead the team that provides insights to get results, as well as develop best-in-class tools to project and forecast Stars performance
- Policy - Craft the evolution of quality through advocacy
- Client Growth and Retention - Win new clients and grow services with existing clients by differentiating CVS Health ability to support their quality goals
As a successful Director, you will possess the ability to independently set the agenda, align stakeholders to the agenda, set accountability to achieve flawless execution provide project management leadership. You will develop a track record in building consensus and cultivating relationships with internal and external technical and business staff. You will need extraordinary written communication, oral communication, and presentation skills in order to strategically plan, organize, and time manage. You will be required to have impeccable attention to detail, with excellent social skills. Finally, you should successfully be able to work cross-functionally to implement new requirements and creative solve problems where standard resolutions do not exist. The contributions you will make as a Government Quality Programs Director will position CVS Health as a leader in client satisfaction and service in the PBM marketplace.
* 8+ years of demonstrated leadership experience within project management, strategy, or a similar field, within a highly regulated industry.
* 5+ years of client relationship management experience, including the demonstrated ability to analyze and resolve client issues.
* 5+ years of experience gathering business requirements, with a strong understanding of a technical process flow and complex requirements.
* 3+ years of advanced-expert level experience using the Microsoft Office Suite, specifically with Excel, Power Point, Outlook, Word, and Project.
* Must have the ability and flexibility to travel up to 25%.
* Direct PBM experience is preferred.
* Previous experience with Star Ratings/Quality Assurance is desired.
Bachelor's degree is required; equivalent work experience may substitute.
MBA is preferred.
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.
CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT
Job ID: 725512BR