Manager – Medical Policy Business Reporting

Job not on LinkedIn

🔥 6 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $54.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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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