Work from Home Remote Job Quality Manager – Clinical Performance at CVS Health
If you’re looking for a remote work-from-home job that allows you to make a positive impact in the healthcare field, CVS Health is hiring a Quality Manager – Clinical Performance.
This role offers the opportunity to work remotely while contributing to healthcare innovation and improving customer experiences.
Remote Work from Home Job Quality Manager
CVS Health is committed to making healthcare more personal, convenient, and affordable. Their core mission is to put the heart in healthcare, and they believe every employee plays a vital role in delivering on this promise.
| Qualification | Details |
|---|---|
| Risk Adjustment | 3+ years experience |
| Licensing | RN, NP, or PA license preferred |
| Certified Coder | Active CRC, CPC, CCS-P certification required |
| Medicare Advantage | Experience with Medicare Advantage products |
| Clinical Knowledge | Strong knowledge of chronic illness management |
| Project Management | Experience managing complex projects |
| Education | Bachelor’s Degree preferred |
| Remote Work | Yes |
As a Quality Manager – Clinical Performance, your main responsibility will be to ensure that work processes meet high standards of quality and efficiency. You’ll be managing audits, conducting analyses, and leading multiple projects to improve the quality of services.
This role also involves working with senior leadership and other departments to implement improvements and ensure compliance with quality standards.
Key Responsibilities:
- Monitor Quality: Measure and assess the effectiveness of work processes, ensuring they meet quality standards and improve customer satisfaction.
- Lead Audits: Manage complex audits, including those related to financial risk and value.
- Project Management: Lead multiple, high-complexity projects, including planning, execution, and evaluation.
- Collaborate: Work closely with leadership teams and cross-functional departments to implement corrective actions and process improvements.
- Reporting: Draft audit reports and communicate project outcomes to senior leadership.
- Process Improvement: Oversee the completion of improvements and ensure that solutions enhance the quality of work.
Required Qualifications:
- Risk Adjustment Experience: At least 3 years of experience in risk adjustment.
- Licensing: Preferably an active RN, NP, or PA license.
- Certified Coder: Active certification through AHIMA or AAPC (CRC, CPC, CCS-P) is required.
- Medicare Advantage: Experience working with Medicare Advantage products.
- Clinical Knowledge: Strong understanding of chronic illness diagnosis, treatment, and management.
- Remote Work: The ability to work independently from home, meeting tight deadlines without direct supervision.
Preferred Qualifications:
- Project Management: Significant experience managing projects in Medicare Advantage or ACA.
- Vendor Management: Experience working with vendors offering supplemental benefits.
- Audit Experience: Experience with audits and insurance-related work, with high proficiency in relevant areas.
Education:
- A Bachelor’s Degree in a related field (Public Health, Health Care Informatics, Risk Management) is preferred. An advanced degree is a plus.
Salary Range:
The salary for this position ranges from $54,300 to $145,860 annually, depending on experience, education, and location. In addition to the base salary, CVS Health offers bonuses, commissions, or short-term incentives.
Why Work for CVS Health?
CVS Health offers a supportive environment where employees can work remotely and contribute to making healthcare better. As a Quality Manager, you’ll have the opportunity to lead impactful projects while enjoying the flexibility of working from home.
How to Apply:
If you’re passionate about healthcare quality and want to work remotely, this could be the perfect job for you. Apply today and help CVS Health deliver high-quality, human-centered care.
