Position SummaryThe
Senior Manager, Quality Assurance and Audit is a critical leadership role responsible for the strategic oversight and execution of quality programs within the Grievance & Appeals QA organization. This role ensures operational excellence, regulatory compliance, and audit readiness across Medicare, Medicaid, and Duals lines of business.
The Senior Manager leads and develops a high-performing team of Quality Analysts and serves as a subject matter expert for G&A quality standards, policies, and audit processes. This leader partners cross-functionally to drive continuous improvement, mitigate compliance risk, and deliver best-in-class quality outcomes in a highly regulated environment.
Key ResponsibilitiesQuality Strategy & Oversight- Design, implement, and continuously improve internal QA processes to deliver best-in-class audit performance and compliance outcomes
- Lead oversight of case and letter quality reviews, ensuring accuracy, timeliness, and adherence to regulatory requirements
- Conduct regular quality audits and case reviews; identify trends, risks, and improvement opportunities
Audit Leadership & Regulatory Readiness- Lead internal and external audit preparation, presentations, and responses, including state and federal regulatory audits
- Serve as a primary quality and compliance liaison during external reviews and examinations
- Provide expert input for policy updates, system enhancements, and regulatory interpretation
People Leadership & Performance Management- Lead, mentor, and develop a team of Quality Analysts in a remote environment
- Track, monitor, and manage staff quality performance, providing ongoing feedback, coaching, and corrective action plans as needed
- Ensure completion of required training, continuing education, and skill development for QA staff
Operational Excellence- Perform daily monitoring of inventory to support timeliness standards and workload balancing
- Collaborate on the development and maintenance of QA desktops, job aids, and training materials
- Partner with operational, compliance, and leadership teams to support enterprise quality goals
Required Qualifications- 7+ years of experience of quality or audit responsibility in Medicare, Medicaid, and/or Duals Grievance & Appeals, with demonstrated QA or oversight responsibility
- Proven experience leading external regulatory audits and formal quality reviews
- Deep knowledge of integrated G&A regulatory requirements
- Experience leading and developing remote teams
- Strong training, mentoring, and coaching experience (virtual and/or in-person)
- Advanced communication, analytical, and supervision skills
Preferred Qualifications- Experience with state and federal regulatory requirements
- Strong deductive reasoning and advanced analytical skills
- Proficiency with Microsoft Office Suite and Quickbase
- Demonstrated problem-solving ability in complex, regulated environments
- Collaborative, team-oriented leadership style
Education- Bachelor's degree or equivalent combination of education and relevant experience
Pay RangeThe typical pay range for this role is:
$67,900.00 - $182,549.00
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. This position also includes an award target in the company's equity award program.
Great benefits for great peopleWe 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: 07/15/2026
