Quality Auditor Grievance - Appeals Senior Manager

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 & Performance Management Lead, mentor, and develop a team of Quality Analysts in a remote environment Track, monitor, and manage staff quality performance, providing ongoing feedback, coaching, and corrective action plans as needed Ensure completion of required training, continuing education, and skill development for QA staff Operational Excellence Perform daily monitoring of inventory to support timeliness standards and workload balancing Collaborate on the development and maintenance of QA desktops, job aids, and training materials Partner with operational, compliance, and leadership teams to support enterprise quality goals Required Qualifications 7+ years of experience of quality or audit responsibility in Medicare, Medicaid, and/or Duals Grievance & Appeals , with demonstrated QA or oversight responsibility Proven experience leading external regulatory audits and formal quality reviews Deep knowledge of integrated G&A regulatory requirements Experience leading and developing remote teams Strong training, mentoring, and coaching experience (virtual and/or in-person) Advanced communication, analytical, and supervision skills Preferred Qualifications Experience with state and federal regulatory requirements Strong deductive reasoning and advanced analytical skills Proficiency with Microsoft Office Suite and Quickbase Demonstrated problem-solving ability in complex, regulated environments Collaborative, team-oriented leadership style Education Bachelor's degree or equivalent combination of education and relevant experience Pay Range The typical pay range for this role is: $67,900.00 - $182,549.00 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: 08/19/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health