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As a Lead Director of Quality Management, you will provide strategic leadership, oversight, and execution of quality improvement, regulatory quality programs, provider performance initiatives, accreditation activities, and population health strategies that support Kentucky Medicaid members and providers.
This role serves as the market quality leader and is responsible for driving measurable improvements in quality outcomes, member experience, health equity, provider engagement, and regulatory performance while aligning market activities with enterprise Medicaid quality objectives.
Primary Responsibilities
- Lead development and execution of the Kentucky Medicaid Quality Strategy.
- Direct quality improvement initiatives focused on regulatory, contractual, and enterprise quality objectives.
- Drive performance improvement efforts for HEDIS®, QRS, state quality metrics, value-based incentives, and market-specific performance goals.
- Provide leadership and oversight for Quality Assessment and Performance Improvement (QAPI) activities.
- Oversee regulatory quality reporting, state deliverables, and Performance Improvement Projects (PIPs).
- Ensure readiness for NCQA, EQRO, CMS, state audits, accreditation activities, and regulatory reviews.
- Partner with Market Leadership, Medical Affairs, Population Health, Care Management, Provider Relations, Network, and Operations to improve member outcomes and reduce health care disparities.
- Lead provider performance improvement strategies, including provider engagement, practice transformation, and quality interventions.
- Monitor quality performance trends and identify opportunities for improvement through data-driven analysis and targeted action plans.
- Develop and present executive-level performance reports, recommendations, and strategic updates to divisional and market leadership.
- Support implementation of enterprise initiatives related to digital quality, interoperability, value-based care, behavioral health, maternal health, preventive care, and chronic condition management.
- Provide leadership, coaching, and development for quality team members.
- Foster a culture of accountability, innovation, continuous improvement, and collaboration.
Required Qualifications
- Must reside in the state of Kentucky
- 10 years of experience in healthcare quality, managed care, population health, clinical operations, healthcare administration, or a related field.
- 7+ years of leadership experience.
- Experience leading quality improvement initiatives and performance management programs.
- Knowledge of Medicaid quality programs, regulatory requirements, and healthcare quality measurement.
- Experience working with HEDIS, NCQA, CMS, accreditation standards, and performance improvement methodologies.
- Demonstrated ability to lead cross-functional initiatives and influence leaders across multiple business areas.
- Strong analytical, communication, and executive presentation skills.
Preferred Qualifications
- Medicaid managed care experience.
- NCQA accreditation experience.
- Population Health and Health Equity expertise.
- Provider engagement and practice transformation experience.
- Experience with value-based care and provider incentive programs.
- Knowledge of interoperability, supplemental data strategies, and quality reporting modernization.
- Registered Nurse (RN) license preferred.
- Master's degree preferred.
Education
- Bachelor's degree required.
- Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or related field preferred.
Position Impact
This role is accountable for market quality performance, regulatory compliance, accreditation readiness, provider quality engagement, health equity advancement, and execution of enterprise Medicaid quality strategies. The position directly influences member outcomes, quality incentive performance, provider collaboration, regulatory success, and overall market performance.
The Kentucky Lead Director of Quality serves as the market's senior quality leader and strategic advisor for Medicaid quality performance. The role is responsible for ensuring achievement of contractual quality requirements, supporting provider performance improvement, advancing population health initiatives, reducing health disparities, strengthening quality governance, and partnering across the organization to improve clinical outcomes and financial performance tied to quality results. This position is critical to maintaining continuity of leadership and execution of Kentucky's quality strategy.
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.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Must reside in Kentucky
- 10 years of experience in healthcare quality, managed care, population health, clinical operations, healthcare administration, or a related field
- 7 or more years of leadership experience
- Experience leading quality improvement initiatives and performance management programs
- Knowledge of Medicaid quality programs, regulatory requirements, and healthcare quality measurement
- Experience with HEDIS, NCQA, CMS, accreditation standards, and performance improvement methodologies
- Ability to lead cross-functional initiatives and influence leaders across multiple business areas
- Strong analytical, communication, and executive presentation skills
- Bachelor's degree
- Medicaid managed care experience
- NCQA accreditation experience
- Population health and health equity expertise
- Provider engagement and practice transformation experience
- Experience with value-based care and provider incentive programs
- Knowledge of interoperability, supplemental data strategies, and quality reporting modernization
- Registered Nurse license
- Master's degree in Nursing, Healthcare Administration, Public Health, Business Administration, or a related field
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
