At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary:
The Lead Director is responsible for leading and optimizing Quality Operations, including all internal resources and outsourced support. This role will administer the strategy for monitoring and improving operational functions aligning policies and procedures with organizational objectives. Controls performance management and contributes to top-level decision making for the Customer Facing Operations Organization. This individual will develop and implement a comprehensive Quality roadmap to enhance client satisfaction, drive operational efficiency, and foster continuous improvement. The ideal candidate will be a strategic leader with a deep understanding of Quality best practices, technology solutions, and outsourcing partnerships.
Key Responsibilities:
- Develops and implements a comprehensive quality strategy aligned with the organization's overall objectives by defining quality goals, performance targets, and key performance indicators (KPIs).
- Leads continuous improvement initiatives to enhance quality management processes, increase efficiency, and reduce defects across the organization.
- Collaborates with various departments, such as Core Operations - Claims, Plan Build, Eligibility, Appeals, Compliance and Client Management, to ensure quality considerations are integrated into all aspects of the organization's operations.
- Establishes and maintains a robust quality management system by developing quality policies, procedures, and guidelines that comply with industry standards and regulatory requirements.
- Identifies potential quality-related risks and develops risk mitigation strategies to ensure the organization's products or services meet established quality standards.
- Analyzes quality data and generates regular reports on KPIs and quality metrics using data-driven insights to communicate quality performance to senior management.
- Ensures that quality initiatives and projects align with customer needs and requirements to enhance customer satisfaction.
- Manages the budget and allocates resources effectively to support quality improvement efforts.
- Provides leadership and guidance to quality management teams, overseeing their work, conducting performance evaluations, and providing training and development opportunities.
- Responsible for bringing forward new technology and service processes that will result in improved member and provider experiences, while also driving efficiencies in the customer service organization.
- Manage and optimize relationships with outsourcing partners to ensure performance, cost-effectiveness, and seamless integration with internal operations.
- Implement and leverage technology solutions, such AI chatbots and other automation tools, to enhance service capabilities.
- Sets strategic direction and influencing change that resulted in quantifiable positive outcomes.
- Ensures regulatory compliance.
- Collaborate with cross-functional teams, including Client Management, Local Market Development, IT and others to drive a customer-centric culture and improve service touchpoints. Develops and maintains strong collaborative relationships maintain excellent lines of communication and share resources to meet common service center objectives.
- Develop and implement training programs to ensure teams are equipped with the skills and knowledge to provide exceptional support.
- Stay informed of industry trends, customer expectations, and emerging technologies to maintain a competitive edge.
Required Skills:
- 5+ years' experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application.
- 5 + years' Quality or Work Process Auditing with a proven track record of developing and executing strategies that improve satisfaction and operational efficiency.
- 5 + years' management and leadership experience.
- 3 + years’ experience managing outsourced service providers, ensuring contractual and performance expectations are met.
- Adept at execution and delivery (planning, delivering, and supporting) skills
- Certified Manager of Quality / Organizational Excellence (CMQ/OE) preferred.
Preferred Qualifications:
- Adept at business intelligence
- Mastery of problem solving and decision-making skills
- Mastery of growth mindset (agility and developing yourself and others) skills
Education:
- Bachelor's degree in a closely related field, or equivalent combination of education and experience.
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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
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No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
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Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 05/13/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Top Skills
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.
