Senior Manager - Quality – Medicare Appeals - PA - Work from home | CVS Health Job

The Senior Manager - Quality – Medicare Appeals leads the development and execution of a data-driven quality strategy across Quality functions.

This role is responsible for identifying trends, developing insights, and ensuring that findings are translated into actionable improvements with measurable outcomes. The position partners closely with Audit, Operations, Reporting, and Business Compliance to support continuous improvement, regulatory alignment, and audit readiness.

Key Responsibilities

• Lead cross-functional analysis of quality, audit, and operational data to identify trends and improvement opportunities

• Develop and present regular insights and performance reporting to leadership

• Drive action planning and follow-up, ensuring clear ownership, timelines, and measurable results

• Facilitate governance forums (e.g., steering committees, workgroups) to prioritize initiatives and track progress

• Partner with Audit, Operations, Reporting, and Business Compliance to support compliance alignment and audit readiness

• Support implementation of process improvements, policy changes, and training initiatives

• Monitor performance indicators (including quality and OMT metrics) to identify risks and recommend corrective actions

• Promote consistency and standardization across quality processes and workflows

Team Leadership

• Manage a team of senioranalysts, and Associate Managers

• Foster a culture of accountability, innovation, and continuous improvement

• 5+ years of experience in Medicare operations, quality, audit, or analytics

• Experience working with data analysis, reporting, and performance management

• Demonstrated ability to translate insights into operational improvements

• Strong problem-solving and cross-functional collaboration skills

• Effective communication and ability to present insights to leadership

• Experience in Medicare Appeals, Quality Assurance, or Audit environments

• Familiarity with CMS regulations and compliance processes

• Experience leading cross-functional initiatives or governance models

• Strong analytical and reporting tool experience (e.g., dashboards, BI tools)