Manager – Medical Policy Business Reporting

Vaga não está no LinkedIn

🕒 Outubro 8

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $54.300 - $145.860 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 17%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 34 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Repostada uma vez.

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CVS Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1963

🏥 Saúde

⚕️ Seguro de Saúde

🛒 Varejo

Healthcare • Healthcare Insurance • Retail

CVS Health é uma empresa líder de saúde nos Estados Unidos, dedicada a ampliar o acesso e a acessibilidade ao cuidado. A empresa adota uma abordagem abrangente que inclui serviços de saúde, seguro saúde e gestão de benefícios farmacêuticos (PBM). Por meio de suas subsidiárias, como Aetna e CVS Caremark, a CVS Health oferece uma variedade de serviços que promovem o bem-estar, a gestão de condições de saúde e a cobertura acessível de medicamentos prescritos. A CVS Health opera farmácias de bairro, oferece serviços de farmácia por correspondência e gerencia programas de medicamentos de especialidade, com o objetivo de tornar o cuidado com a saúde conveniente e acessível para todos. Movida pela missão de conectar pessoas a serviços essenciais de cuidado, a CVS Health está comprometida em fomentar comunidades mais saudáveis e apoiar o bem-estar de todas as pessoas.

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 • Improve data accessibility and reporting capabilities with data management and technology teams • Promote self-service analytics and reporting capabilities • Monitor policy adherence, implementation effectiveness, internal controls, and regulatory requirements • 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 • Develop and measure performance improvement recommendations • Gather and document reporting, analytics, and operational requirements • Support BRD development, system implementations, strategic initiatives, and transformation efforts • Coordinate cross-functional workgroups, projects, and analytical initiatives • Present insights, risks, trends, and recommendations to business leaders and stakeholders • Provide consultative support on healthcare analytics, reporting methodologies, and performance measurement • Ensure data integrity, consistency, reliability, validation, and issue remediation • Maintain documentation for 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 • Knowledge of medical and payment policy configuration, claims editing, adjudication workflows, and end-to-end claims operations • Experience supporting enterprise governance committees and executive leadership reporting • Experience developing business requirements documents (BRDs), process maps, user stories, and operational workflows • Experience supporting transformation, automation, and operational improvement initiatives • Experience supporting audit readiness, regulatory reviews, and control monitoring programs • Knowledge of predictive analytics, machine learning, or advanced statistical modeling techniques • Bachelor's Degree or equivalent experience

🏖️ Benefícios

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

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