Senior Manager – Medical Policy, Program Solutions

Job not on LinkedIn

🕒 Yesterday

🇺🇸 United States – Remote

💵 $67.9k - $182.5k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Develop and execute strategies to identify, evaluate, prioritize, and advance medical and payment policy optimization opportunities • Leverage claims, appeals, coding, reimbursement, provider, and operational data to identify trends, friction points, and improvement opportunities • Evaluate and modernize policies across the claims lifecycle, including pre-payment and post-payment use • Develop evidence-based recommendations balancing policy intent, clinical and coding standards, provider experience, compliance, and business impact • Establish approaches and performance measures to advance opportunities from analysis through implementation and measurement • Provide strategic leadership for experience optimization programs and maintain a prioritized portfolio aligned with enterprise objectives • Establish intake, prioritization, governance, and decision-making practices • Partner with analytics and technology teams to develop reporting and insights • Evaluate results and translate recurring trends into broader improvement strategies • Lead cross-functional evaluations and translate findings into recommendations, risks, tradeoffs, and expected outcomes • Influence senior leaders and stakeholders across a matrixed organization • Establish partnerships and handoffs across policy development, remediation, configuration, implementation, and operational teams • Provide leadership, coaching, and development to team members

🎯 Requirements

• 5+ years of experience in healthcare, medical or payment policy, payment integrity, coding, claims, appeals, healthcare analytics, provider experience, or related healthcare functions • Supervisory or formal people-leadership experience required • Experience using multiple data sources to identify trends, performance gaps, and optimization opportunities and translate findings into actionable recommendations • Strong knowledge of healthcare reimbursement, claims processing, medical and/or payment policy, and coding concepts, including CPT, HCPCS, and ICD-10 • Experience leading complex, cross-functional initiatives from analysis and recommendation through implementation and measurement • Ability to communicate complex findings, influence decision-making, and collaborate across a matrixed organization • Strong strategic thinking, analytical problem-solving, communication, and stakeholder-management skills • Bachelor’s degree in healthcare administration, business, public health, health informatics, nursing, analytics, or a related field, or equivalent professional experience • Relevant healthcare or coding credential, such as CPC, CCS, RHIT, or an equivalent credential, required or must be obtained within one year of employment

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being