SeniorManager,QualityAssuranceandAudit

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 may reside anywhere in the US **Position Summary** The **Senior Manager, Quality Assurance and Audit** is a critical leadership role responsible for the strategic oversight and execution of quality programs within the Grievance & Appeals QA organization. This role ensures operational excellence, regulatory compliance, and audit readiness across Medicare, Medicaid, and Duals lines of business. The Senior Manager leads and develops a high-performing team of Quality Analysts and serves as a subject matter expert for G&A quality standards, policies, and audit processes. This leader partners cross-functionally to drive continuous improvement, mitigate compliance risk, and deliver best-in-class quality outcomes in a highly regulated environment. **Key Responsibilities** **Quality Strategy & Oversight** * Design, implement, and continuously improve internal QA processes to deliver best-in-class audit performance and compliance outcomes * Lead oversight of case and letter quality reviews, ensuring accuracy, timeliness, and adherence to regulatory requirements * Conduct regular quality audits and case reviews; identify trends, risks, and improvement opportunities **Audit Leadership & Regulatory Readiness** * Lead internal and external audit preparation, presentations, and responses, including state and federal regulatory audits * Serve as a primary quality and compliance liaison during external reviews and examinations * Provide expert input for policy updates, system enhancements, and regulatory interpretation **People Leadership