Candidate must reside in Louisiana

Business Overview

Aetna Better Health of Louisiana, a CVS Health company, is committed to improving the health and wellness of Medicaid members through innovative, high-quality care delivery. We partner with providers, community organizations, and the Louisiana Department of Health (LDH) to advance clinical outcomes, health equity, and member experience across the state.

Position Summary

The Lead Director, Healthcare Quality Management is responsible for the overall leadership, execution, and continuous improvement of the Louisiana Quality Assessment and Performance Improvement (QAPI) program.

This role provides full accountability for quality performance, regulatory compliance, and strategic execution across all quality domains, including HEDIS, P4P/withholds, accreditation, quality of care, and member experience. The Lead Director serves as a key member of the market leadership team and as the primary liaison to LDH for quality-related performance and compliance.

The role also ensures integration of quality strategy across clinical operations, provider engagement, population health, and value-based programs to drive measurable improvements in outcomes and RFP readiness.

This aligns with expectations that the Quality Director leads QAPI, CQI, and accreditation while improving outcomes for Medicaid populations and working closely with state regulators.

Key Responsibilities

1. Quality Strategy & Performance Ownership
• Serve as the "voice of Quality" for the Louisiana market, leading all quality strategy and execution.
• Own end-to-end performance for:

• o HEDIS and hybrid measure performance
• o P4P / withhold maximization
• o CAHPS and member experience
• o Quality of Care and clinical outcomes

• Develop and execute market-specific strategies aligned to enterprise priorities and Measures That Matter Most (MTMM).

2. QAPI Program Leadership & Regulatory Compliance
• Lead and oversee the Louisiana QAPI and Continuous Quality Improvement (CQI) programs in alignment with:

• o LDH contract requirements
• o State and federal regulations
• o NCQA accreditation standards
• Ensure readiness for:
• o NCQA surveys
• o EQRO audits
• o State audits and RFP evaluations

• Maintain documentation, policies, and reporting consistent with regulatory requirements.

3. Market Leadership & External Engagement
• Serve as a key member of market leadership and required personnel for LDH engagement.
• Act as primary Quality contact with:

• o Louisiana Department of Health (LDH)
• o External regulators and auditors
• o Provider partners and delegates

• Lead quality committees and governance structures, ensuring executive oversight of performance and improvement actions.

4. Clinical Quality & Population Health Integration
• Provide clinical oversight for:

• o Quality of Care investigations
• o Performance improvement projects (PIPs)
• o Preventive health and population health initiatives

• Integrate behavioral health, SDoH, and health equity strategies into quality improvement efforts-critical for Louisiana Medicaid populations.

5. Data, Measurement & Performance Improvement
• Direct HEDIS and quality reporting, including:

• o Data collection and validation
• o Measure performance monitoring
• o Gap identification and closure strategies

• Translate data into actionable insights and drive intervention strategies.
• Partner with informatics, provider engagement, and care management to ensure execution.

6. Provider & Value-Based Strategy Alignment
• Lead provider performance strategy, including:

• o Value-Based Contracting (VBC) quality alignment
• o Provider education and engagement
• o Practice transformation initiatives

• Collaborate cross-functionally to embed quality into operational workflows and provider networks.

7. Financial & Operational Accountability
• Maintain full accountability for quality-related financial performance, including:

• o Withholds and incentive programs
• o Quality-related cost management

• Manage budgets and resource allocation while meeting operational goals.

8. Leadership & Team Development
• Lead, develop, and mentor a multidisciplinary quality team.
• Drive a culture of accountability, performance, and continuous improvement.
• Build leadership bench strength aligned with enterprise talent strategy.

Required Qualifications
• 10+ years of healthcare experience
• 5-7+ years in managed care quality leadership
• Demonstrated success leading HEDIS, accreditation, and quality performance programs
• Strong knowledge of Medicaid regulatory requirements and quality frameworks
• Proven ability to lead cross-functional teams and influence senior stakeholders
• Excellent communication, executive presence, and strategic thinking skills

RN or clinical licensure; CPHQ or related certification

Preferred Qualifications
• Experience in Louisiana Medicaid or similar markets
• Experience with LTSS, behavioral health integration, and SDoH initiatives
• Background in value-based care and provider performance management

Education
• Bachelor's degree required or equivalent work experience
• Master's degree preferred

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

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 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: 07/24/2026