Manager – Medical Policy Business Reporting

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🕒 Ontem

🏰 Missouri – Remoto

🏰 Missouri – Remote

💵 $54.300 - $145.860 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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CVS Health Careers

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🛒 Varejo

📦 Logística

Healthcare • Retail • Logistics

CVS Health Careers é a área de recrutamento e employer branding da CVS Health, apresentando oportunidades de trabalho em diversas áreas da empresa — lojas de varejo farmacêutico, serviços de farmácia, clínicas de saúde, centros de distribuição, funções corporativas e transporte. O site de carreiras destaca um trabalho orientado por propósito, focado em melhorar o acesso, a acessibilidade financeira e a qualidade dos cuidados de saúde, além de apresentar uma grande força de trabalho (mais de 300. 000 funcionários), uma cultura inclusiva, benefícios e recursos de contratação para candidatos.

Descrição

• Manage analytics, reporting, performance measurement, and operational intelligence activities supporting Medical Policy and Payment Integrity functions • Translate healthcare, claims, policy, utilization, and operational data into actionable business insights • Manage development and maintenance of performance reporting, scorecards, KPIs, and trend analyses • Analyze policy performance, utilization patterns, coding trends, financial outcomes, and operational effectiveness • Prepare summaries, dashboards, and presentation materials for leadership review • Oversee design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions • Partner with data management and technology teams to improve data accessibility and reporting capabilities • Monitor policy adherence, implementation effectiveness, internal controls, and regulatory compliance • Support governance committees, internal audits, regulatory reviews, corrective action plans, and remediation efforts • Conduct root cause analyses and support continuous improvement, defect reduction, and process optimization • Gather and document reporting, analytics, and operational requirements; support BRD development and technical solution translation • Support strategic initiatives, system implementations, transformation efforts, and business requirements activities • Coordinate cross-functional workgroups, projects, and analytical initiatives • Present insights, risks, trends, and recommendations to business leaders and cross-functional stakeholders • Support data governance, validation, quality monitoring, issue remediation, and documentation of reporting methodologies, metric definitions, and data sources

🎯 Requisitos

• 5+ years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, healthcare operations, or related healthcare functions • 4+ years of experience leading or coordinating projects, analytical workstreams, reporting initiatives, or cross-functional business activities • Advanced analytical, quantitative, and problem-solving skills leveraging AI • Experience developing executive dashboards, scorecards, KPIs, and performance reporting • Experience performing trend analysis, forecasting, root cause analysis, and performance measurement • Ability to coordinate analytical work, manage competing priorities, and influence stakeholders across a matrixed environment • Ability to balance day-to-day operational priorities with longer-term business goals • Ability to communicate complex analytical concepts to technical and non-technical audiences • Strong stakeholder management and relationship-building skills • Advanced Microsoft Excel skills • Experience with Power BI, Tableau, SQL, SAS, Snowflake, Azure Analytics, or similar tools • Bachelor's Degree or equivalent experience • Preferred: Knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations • Preferred: Experience supporting enterprise governance committees and executive leadership reporting • Preferred: Experience developing business requirements documents (BRDs), process maps, user stories, and operational workflows • Preferred: Experience supporting transformation, automation, and operational improvement initiatives • Preferred: Experience supporting audit readiness, regulatory reviews, and control monitoring programs • Preferred: Knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques

🏖️ Benefícios

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Eligibility for CVS Health bonus, commission or short-term incentive program in addition to base pay

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