Description

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.

The Vice President, Health Plan & Provider Quality provides enterprise leadership for quality performance, regulatory compliance, and accreditation readiness across all Aetna Clinical Solutions lines of business. This role integrates health plan quality, provider quality oversight, and clinical data enablement into a unified quality strategy that improves clinical outcomes, member experience, and external quality performance.

The VP is accountable for driving results across HEDIS, CAHPS, Stars, and value‑based arrangements through clinically informed, data‑driven improvement strategies. The role ensures quality standards are consistently applied, performance is transparent and actionable, and ACS maintains strong credibility with regulators, accreditation bodies, providers, and enterprise partners.

Key Responsibilities

• Define and lead the enterprise quality strategy for ACS, aligning clinical programs, operations, and performance management to improve clinical outcomes, member experience, and quality ratings.
• Own quality performance outcomes across Stars, HEDIS, CAHPS, and all state and federal quality programs, ensuring results meet regulatory, contractual, and organizational expectations.
• Ensure compliance with CMS, state Medicaid agencies, NCQA, and other regulatory and accreditation requirements, including audit preparation, execution, and remediation.
• Oversee provider quality and delegated entity oversight, including audits, governance structures, corrective action plans, and ongoing performance monitoring.
• Lead clinical data enablement and quality analytics in partnership with analytics teams, ensuring accurate, timely, and actionable reporting to identify trends, risks, and improvement opportunities.
• Establish and maintain quality governance to proactively identify issues, manage risk, and drive sustained performance improvement.
• Partner with clinical leaders, operational teams, and network providers to embed quality expectations into workflows, care delivery, documentation practices, and performance management.
• Drive clinically informed interventions addressing gaps in care, chronic disease management, preventive services, and population health priorities.
• Support value‑based care and population health initiatives through scalable quality frameworks and performance oversight.

Remote or Hybrid

Qualifications

• Active clinical license (RN, MD/DO, NP, or PA) strongly preferred, or equivalent senior‑level clinical quality experience.
• 15+ years of progressive leadership experience in healthcare quality management, regulatory compliance, and/or clinical performance improvement, preferably in managed care.
• Strong expertise in CMS and Medicaid requirements, accreditation standards (e.g., NCQA), and clinical quality measurement frameworks, including HEDIS and Stars.
• Executive‑level experience leading enterprise‑scale teams and programs with high regulatory and accreditation visibility.
• Proven experience overseeing provider quality, delegated arrangements, and provider‑facing performance improvement initiatives.
• Strong background in clinical data, quality analytics, and performance reporting to drive decision making and outcomes.
• Demonstrated success leading cross‑functional initiatives and engaging directly with regulators, accreditation bodies, and external partners.

Pay Range

The typical pay range for this role is:

$250,000 - $350,000


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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• 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

Pay Range

The typical pay range for this role is:

$0.00 - $0.00

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: 05/18/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.