Manager, Medical Economics

Job not on LinkedIn

🕒 May 22

🏈 Alabama, Arizona, +2 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote

💵 $54.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Perform audits of provider‑related data, and financial arrangements to validate compliance with contract terms, internal policies, and regulatory requirements • Review and assess documentation, calculations, data sources, and system outputs related to Medical Economics processes • Independently identify audit exceptions, root causes, and risk levels, ensuring findings are supported by clear evidence • Apply defined audit criteria, scoring methodologies, and sampling approaches consistently across audits • Serve as a primary audit point of contact within MEU for provider groups, delegated vendors, and network partners when audit activity requires external coordination • Communicate audit scope, findings, and remediation expectations clearly and professionally to external providers and internal network teams • Document audit results, findings, and remediation actions in audit tools, trackers, and workpapers with a high level of accuracy and clarity • Track findings through remediation and verification, escalating risks and delays as needed

🎯 Requirements

• 5+ years working experience • Bachelor’s degree or equivalent experience in healthcare administration, finance, business, economics, or a related field • Experience performing audits, quality reviews, or compliance assessments within healthcare, payer operations, provider networks, or vendor management • Ability to analyze data, documentation, and calculations to identify discrepancies and assess financial or compliance impact • Demonstrated ability engaging with external partners or providers through clear written and verbal communications • Demonstrated ability to manage multiple audits or workstreams while meeting deadlines

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support physical, emotional, and financial well-being of colleagues and their families