Quality Management Lead Director

CVS Health

Lead Director for Healthcare Quality Management overseeing quality strategies for Louisiana Medicaid populations. Responsible for execution of quality management initiatives and regulatory compliance at Aetna Better Health of Louisiana.

Posted 7/21/2026full-timeRemote • Louisiana • 🇺🇸 United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive expertise in leading quality strategy and execution within the healthcare sector, with a strong focus on HEDIS performance, accreditation standards, and regulatory compliance. Proven ability to drive continuous quality improvement and manage cross-functional teams effectively.

Highest-signal resume keywords

HEDIS Performance LeadershipManaged Care Quality LeadershipMedicaid Regulatory KnowledgeQuality Assurance Performance Improvement (QAPI)Clinical Oversight

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Quality Strategy DevelopmentData Collection and ValidationPerformance Improvement Projects (PIPs)Value-Based Contracting (VBC)Quality ReportingGap Identification and ClosureContinuous Quality Improvement (CQI)Accreditation Standards ComplianceFinancial Performance ManagementPopulation Health Initiatives

Soft Skills

Excellent CommunicationStrategic ThinkingExecutive PresenceTeam LeadershipStakeholder Influence

Certifications & Qualifications

RN LicensureCPHQ Certification

Industry Keywords

Healthcare ExperienceManaged CareNCQA AccreditationQuality of CareRegulatory CompliancePerformance MetricsMember ExperienceProvider EngagementClinical OutcomesQuality Frameworks

About the role

Key responsibilities & impact

Serve as the “voice of Quality” for the Louisiana market, leading all quality strategy and execution.
Own end-to-end performance for: HEDIS and hybrid measure performance, P4P / withhold maximization, CAHPS and member experience, Quality of Care and clinical outcomes.
Develop and execute market-specific strategies aligned to enterprise priorities and Measures That Matter Most (MTMM).
Lead and oversee the Louisiana QAPI and Continuous Quality Improvement (CQI) programs in alignment with contract requirements, State and federal regulations, NCQA accreditation standards.
Ensure readiness for NCQA surveys, EQRO audits, State audits and RFP evaluations.
Maintain documentation, policies, and reporting consistent with regulatory requirements.
Act as primary Quality contact with Louisiana Department of Health (LDH), External regulators and auditors, Provider partners and delegates.
Provide clinical oversight for Quality of Care investigations, Performance improvement projects (PIPs), Preventive health and population health initiatives.
Direct HEDIS and quality reporting, including Data collection and validation, Measure performance monitoring, Gap identification and closure strategies.
Lead provider performance strategy, including Value-Based Contracting (VBC) quality alignment, Provider education and engagement, Practice transformation initiatives.
Maintain full accountability for quality-related financial performance, including Withholds and incentive programs, Quality-related cost management.
Lead, develop, and mentor a multidisciplinary quality team, driving a culture of accountability, performance, and continuous improvement.

Requirements

What you’ll need

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

Benefits

Comp & perks

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families