Manager - Healthcare Quality - Project Management (IC)
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Manager - Healthcare Quality - Project Management
A Brief Overview
Leads behavioral health population health and quality improvement initiatives that help Louisiana Medicaid members access the care, services, and support they need to achieve their best health. Collaborates across clinical, operational, provider, community, and state partners to assess population health needs, implement evidence-based interventions, manage Performance Improvement Projects (PIPs), and evaluate outcomes. Uses data-driven strategies to improve health outcomes, reduce barriers to care, support health equity, and enhance the overall member and provider experience.
Position Summary
The Behavioral Health Quality Project Manager is a strategic member of the Quality and Population Health team responsible for leading behavioral health population health initiatives, Performance Improvement Projects (PIPs), quality improvement activities, regulatory reporting, and population-based interventions for Louisiana Medicaid members.
This position leads the assessment, design, implementation, monitoring, and evaluation of behavioral health population health strategies aimed at improving access to care, health outcomes, member experience, care coordination, and quality performance across behavioral health populations. The role develops data-driven improvement strategies, manages state-required Performance Improvement Projects, evaluates intervention effectiveness, and collaborates with internal and external stakeholders to address identified barriers impacting member outcomes.
Key Responsibilities (What you will do)
Population Health Strategy, Assessment, and Planning
- Lead behavioral health population health initiatives designed to improve outcomes for members with mental health conditions, substance use disorders, co-occurring conditions, and other behavioral health needs.
- Conduct annual and ongoing behavioral health population health assessments to identify priority populations, health disparities, gaps in care, social drivers of health, utilization patterns, and improvement opportunities.
- Analyze claims data, quality performance data, utilization trends, member feedback, provider feedback, community data, and population health indicators to identify intervention opportunities.
- Support development, implementation, and evaluation of behavioral health components of the annual Population Health Management Strategy.
- Develop strategic recommendations that address access, engagement, care coordination, quality outcomes, health equity, and behavioral health integration priorities.
- Monitor emerging behavioral health trends, evidence-based practices, regulatory requirements, and community needs to inform strategic planning efforts.
- Establish population health goals, intervention strategies, tracking methods, and outcome measures aligned with organizational and state priorities.
Performance Improvement Projects (PIPs)
- Lead end-to-end management of Behavioral Health Performance Improvement Projects (PIPs), including project design, implementation, monitoring, evaluation, and reporting.
- Coordinate development and maintenance of study methodologies, target populations, study questions, intervention strategies, barrier analyses, performance indicators, intervention tracking measures, and improvement goals.
- Conduct ongoing assessment of intervention effectiveness and recommend intervention adoption, expansion, modification, replacement, or discontinuation based on measured outcomes.
- Partner with Informatics and analytics teams to validate data, measure calculations, intervention metrics, and reporting accuracy.
- Maintain project plans, implementation timelines, risk logs, decision logs, evidence repositories, submission calendars, and reporting documentation.
- Coordinate quarterly, annual, and ad hoc PIP reporting activities and regulatory submissions.
- Support responses to state agency, EQRO, audit, accreditation, and leadership requests associated with behavioral health quality initiatives.
Quality Performance Monitoring and Outcomes Evaluation
- Monitor behavioral health quality measures including Follow-Up After Hospitalization for Mental Illness (FUH), Follow-Up After Emergency Department Visit for Mental Illness (FUM), Follow-Up After Emergency Department Visit for Substance Use Disorder (FUA), and other applicable HEDIS, state, and organizational quality measures.
- Collaborate with analytics teams to validate quality measure performance and identify opportunities for improvement.
- Conduct root cause analyses, barrier analyses, and performance gap assessments.
- Monitor intervention tracking measures and evaluate outcomes using quantitative and qualitative data.
- Develop recommendations to improve quality performance, member outcomes, provider engagement, and care coordination.
- Prepare dashboards, scorecards, executive summaries, presentations, and reports communicating performance results and strategic recommendations.
- Present findings to leadership, quality committees, provider groups, state stakeholders, and other audiences.
Provider, Member, and Community Engagement
- Partner with provider-facing and member-facing teams to translate population health strategies into actionable improvement activities.
- Develop provider education initiatives supporting evidence-based practices, trauma-informed care, health equity, integrated care, behavioral health quality measures, and care coordination.
- Develop member outreach and engagement campaigns aimed at improving awareness, follow-up care, treatment adherence, and access to services.
- Collaborate with community organizations, advocacy groups, healthcare providers, and vendor partners to support statewide population health objectives.
- Facilitate stakeholder workgroups and cross-functional meetings focused on behavioral health quality improvement.
- Promote person-centered, culturally responsive, recovery-oriented, and non-stigmatizing approaches throughout behavioral health improvement efforts.
Health Equity and Social Drivers of Health
- Integrate health equity and social drivers of health considerations into population health assessments, intervention planning, and quality improvement activities.
- Identify disparities impacting behavioral health access, utilization, engagement, and outcomes.
- Develop targeted strategies for high-risk, underserved, rural, and vulnerable populations.
- Partner with community organizations and stakeholders to address barriers affecting member health outcomes.
- Support initiatives addressing behavioral health workforce shortages, access disparities, and community-specific needs.
Regulatory Compliance, Accreditation, and Governance Duties
- Support compliance with Louisiana Medicaid, contractual, regulatory, accreditation, NCQA, and organizational quality requirements.
- Maintain complete, audit-ready documentation supporting population health and quality initiatives.
- Support NCQA accreditation readiness, quality reporting, and program documentation activities.
- Prepare materials and status updates for quality committees, governance meetings, leadership reviews, and regulatory stakeholders.
- Participate in multidisciplinary committees, workgroups, and strategic planning efforts focused on quality and population health improvement.
- Ensure confidentiality and compliance with HIPAA and organizational policies.
Minimum Qualifications
Education
- Bachelor’s degree in Public Health, Population Health, Healthcare Administration, Behavioral Health, Psychology, Counseling, Social Work, Nursing, Health Sciences, Business Administration, Project Management, or a related field.
Experience
- Three or more years of experience in Healthcare Quality, Population Health, Behavioral Health, Medicaid Managed Care, Quality Improvement, Program Management, Project Management, or a related healthcare field.
- Experience leading complex cross-functional projects involving multiple stakeholders.
- Experience analyzing healthcare quality, utilization, population health, or clinical performance data.
- Experience developing and implementing quality improvement or population health interventions.
- Experience preparing presentations, reports, and recommendations for leadership audiences.
Required Skills
- Performance Improvement Project (PIP) Management
- Quality Improvement Methodologies
- Data Analysis and Performance Monitoring
- Project Management
- Root Cause and Barrier Analysis
- Provider and Stakeholder Engagement
- Executive Communication and Presentation
- Cross-Functional Collaboration
- Strategic Planning and Execution
- Microsoft Office Suite and Collaboration Platforms
Preferred Qualifications
- Master's degree in Public Health, Population Health, Healthcare Administration, Counseling, Social Work, Psychology, Behavioral Health, or a related field.
- Louisiana behavioral health licensure (LPC, LPC-S, LCSW, LCSW-BACS, or equivalent) preferred.
- Experience supporting Louisiana Medicaid or Managed Care Organization quality programs.
- Experience conducting population health needs assessments and translating findings into intervention strategies.
- Experience with NCQA accreditation, HEDIS measures, EQRO activities, and quality program oversight.
- Experience managing state-required Performance Improvement Projects.
- Experience developing provider engagement, member engagement, or community partnership strategies.
- Experience supporting behavioral health integration, health equity, social drivers of health, and community-based population health initiatives.
- Certified Professional in Healthcare Quality (CPHQ), Project Management Professional (PMP), Lean Six Sigma, or similar certification.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,300.00 - $119,340.00
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.
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: 10/13/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
About CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
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