We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
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.
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:
· 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:
· 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:
· Lead quality committees and governance structures, ensuring executive oversight of performance and improvement actions.
4. Clinical Quality & Population Health Integration
· Provide clinical oversight for:
· 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:
· 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:
· 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:
· 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.
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.
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
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues.
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 simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.
