Senior Manager – Quality, Medicare Appeals

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🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

👔 Manager

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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

• Lead cross-functional analysis of quality, audit, and operational data to identify trends and improvement opportunities • Develop and present regular insights and performance reporting to leadership • Drive action planning and follow-up with clear ownership, timelines, and measurable results • Facilitate governance forums such as steering committees and workgroups • Partner with Audit, Operations, Reporting, and Business Compliance to support compliance alignment and audit readiness • Support implementation of process improvements, policy changes, and training initiatives • Monitor quality and OMT performance indicators to identify risks and recommend corrective actions • Promote consistency and standardization across quality processes and workflows • Manage a team of senior analysts and Associate Managers • Foster accountability, innovation, and continuous improvement

🎯 Requirements

• 5+ years of experience in Medicare operations, quality, audit, or analytics • Experience with data analysis, reporting, and performance management • Ability to translate insights into operational improvements • Strong problem-solving and cross-functional collaboration skills • Effective communication and ability to present insights to leadership • Experience in Medicare Appeals, Quality Assurance, or Audit environments preferred • Familiarity with CMS regulations and compliance processes preferred • Experience leading cross-functional initiatives or governance models preferred • Strong analytical and reporting tool experience, such as dashboards and BI tools, preferred • Bachelor's degree in Business, Healthcare Administration, or related field • Master's degree preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s 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