Senior Manager, Quality Care - Aetna Mercy Care AZ - RN

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. The Senior Manager, Quality of Care is responsible for leading and coordinating comprehensive quality assurance activities across healthcare operations. This role ensures the integrity of care delivery through the management of Quality of Care investigations and oversight of Seclusion and Restraint practices, in alignment with regulatory standards and organizational policies. This position requires strong leadership, clinical knowledge, and the ability to navigate complex regulatory environments while promoting a culture of safety and excellence. This is a fully remote position. Eligible candidates must live in Arizona.

Key Responsibilities

• Quality of Care Investigations: Lead and manage investigations into care concerns, ensuring timely resolution, thorough documentation, and implementation of corrective actions.
• Seclusion and Restraint Oversight: Monitor and evaluate the use of seclusion and restraints, ensuring compliance with clinical guidelines and safety protocols. Prepare and present monthly and quarterly reports to the Quality Committee.
• Staff Management: Supervise and support quality and safety staff, fostering a culture of accountability, continuous improvement, and professional development.
• After-Hours On-Call Response: Serve as the primary on-call contact for urgent health and safety issues, including Immediate Jeopardy (IJ) situations, ensuring rapid response and coordination with internal and external stakeholders.
• Mortality Committee Leadership: Facilitate and lead mortality review meetings, analyze trends, and drive system-level improvements based on findings.
• Peer Review Support: Collaborate with clinical leadership to assist in peer review case preparation and follow-up, ensuring fairness, transparency, and adherence to policy.
• Quality Committee Participation: Actively contribute to the organization’s Quality Committee by presenting findings, updates, and strategic recommendations to enhance care outcomes.
• Data Analysis & Reporting: Compile, analyze, and interpret clinical and operational data to identify trends, support decision-making, and inform quality improvement initiatives. Develop and deliver reports and presentations for internal stakeholders and committees.

Required Qualifications

• Arizona resident
• Active and unrestricted Arizona RN license
• Minimum 7 years of clinical experience
• At least 3 years of experience in healthcare quality management
• Minimum 3 years of clinical leadership experience, including direct staff management
• Demonstrated experience in data analysis and reporting, with strong ability to extract, interpret, and present data
• High proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams)
• Ability to travel up to 10% in state for leadership meetings in Phoenix or visits to facilities as needed for assistance with incidents
• Ability to participate in on-call rotation

Preferred Qualifications

• Experience working with Medicaid populations
• Familiarity with QuickBase or similar data management platforms

Education Registered nurse, BSN or MSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $100,425.00 - $216,300.00 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 12/06/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job