Executive Ncqa Accreditation Jobs (NOW HIRING)

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 ourselvesaccountable 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, Clinical Operations is a transformative operations leader responsible for providing strategic leadership, clinical oversight, and executing enterprise strategy across a dynamic portfolio of clinical programs-including Prior Authorization and Appeals, Medication Therapy Management (MTM), Pharmacy Advisor, and Safety & Quality Management (SQM)- at a time of significant industry evolution. This executive will architect and deliver scalable, value-driven business models across these programs to sustain growth, operational excellence, and best-in-class clinical outcomes. Lines of business include Medicare, Medicaid, Commercial, Individual Exchange, and Commercial Specialty across pharmacy and medical benefit.

These services represent significant operational expense and revenue, with year over year growth expected.

This leader is responsible for planning and executing a strategy that ensures we are achieving the highest levels of efficiency and compliance to deliver best in class member care to our members and clients. This role is responsible for the collaboration with internal business areas such as Client Services, Marketing, Regulatory Affairs, Accreditation, Product, Trade, Pharmacy Operations, Member Operations, Account Management, Finance, DDAT, and support partners to deliver service quality and compliance standards according to CMS, state and federal regulations, URAC and NCQA accreditation standards, and UM goals.

The VP will also be a key stakeholder in building a sustainable, scalable operation while delivering on aspirational goals around automation and augmentation, colleague performance, and meeting a demanding market and client landscape.

Span of new organization includes 3 Direct Reports, 4,205 indirect reports at peak (full time employees and contingent workers).

Responsibilities include:

1. Strategic Leadership & Organizational Effectiveness

• Provides executive leadership for a large, complex organization, establishing the vision, strategy, and operating framework necessary to achieve enterprise and business objectives.
• Builds a high-performing leadership team focused on operational excellence, organizational effectiveness, talent development, and sustained business results.
• Cultivates strong cross-functional partnerships to address enterprise opportunities, enhance member outcomes, and drive strategic alignment across the organization.

2. Enterprise Strategy & Transformation

• Shapes and influences the strategic direction of Clinical Operations and key enterprise initiatives.
• Partners with senior executives to identify opportunities for innovation, growth, operational transformation, and competitive differentiation.
• Serves as an executive sponsor for critical business initiatives, ensuring organizational readiness, scalable execution, and alignment with enterprise priorities while fostering a culture of innovation, accountability, and continuous improvement.

3. Enterprise Performance & Financial Stewardship

• Maintains ultimate accountability for organizational performance, including financial management, operational results, member and client experience, and achievement of strategic business objectives.
• Drives sustainable growth, operational excellence, and continuous improvement through disciplined execution, data-driven decision-making, and effective allocation of organizational resources.
• Ensures delivery of measurable value to members, clients, and the enterprise.

4. Operational Strategy & Business Execution

• Provides executive oversight for all operational functions, ensuring strategic priorities, organizational capabilities, and operating models support current and future business needs.
• Balances enterprise transformation efforts, client commitments, and operational performance while driving efficiency, scalability, and innovation.
• Ensures execution excellence and organizational adaptability without compromising service quality or member experience.

5. Member, Client & Colleague Experience

• Champions CVS Health's Ambition, Purpose and Values in the experience of our members, clients, and colleagues.
• Establishes a member-centric culture that reinforces accountability, engagement, and service excellence at every level of the organization.
• Ensures leaders understand the direct connection between colleague experience, organizational culture, operational performance, and member outcomes.

6. Executive Influence & Communication

• Serves as a trusted advisor and influential executive leader, effectively communicating business strategy, organizational priorities, and transformation initiatives to internal and external stakeholders.
• Demonstrates executive presence and strategic acumen while building credibility with enterprise leaders, clients, and key partners.
• Translates complex business challenges into clear direction, enabling alignment, engagement, and successful execution across the organization.

Required Qualifications

• 15+ years of professional experience leading complex customer operations with support to members and clients
• 15+ years of experience demonstrating the ability to identify and define business problems and opportunities, develop strategic and analytical frameworks to conduct analysis resulting in optimal operational efficiencies

Preferred Qualifications:

• 10+ years of experience within a Pharmacy Benefit Management
• Pharmacy license preferred but not required

Skills:

• Organize, prioritize, and manage multiple tasks on a regular basis with elevated level of detail
• Superior Oral and Written communication skills
• Proven development of teams and skill building competencies
• Strong Customer Service orientation both internally and externally
• Experience in Change Management practices
• Demonstrates resourcefulness in complex problem-solving
• Displays confidence and aptitude to digest complex material and provide timely solutions
• Proficient computer knowledge including Microsoft office products and Windows based operations

Pay Range

The typical pay range for this role is:

$240,000-$300,000

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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