CVS Health · 4 hours ago
Manager, Program Management
United States
Full-time
Remote
Mid, Senior Level
$54K/yr - $119K/yr
5+ years expCVS Health is dedicated to building a world of health around every individual, and they are seeking a Manager of Program Management to facilitate the implementation of Medicaid health plan operations programs. This role involves coordinating with cross-functional teams to enhance operational efficiency, ensure compliance, and manage stakeholder relationships.
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Responsibilities
Facilitates the successful implementation of Medicaid health plan operations programs by coordinating with cross-functional teams
Enhances operational efficiency, ensures compliance with regulatory standards, and contributes to the overall success of healthcare operations
Assists in the management of stakeholder relationships and establishes communication channels to promptly address concerns regarding claims payment, contract or benefit setup
Collect, analyze, and interpret operational data to identify trends, patterns, and insights that inform decision-making and drive improvements in operations
Analyze operational issues, incidents, and provider complaints and identify root causes, propose solutions, and collaborate with relevant teams to implement corrective actions, claims payment reconfiguration and prevent recurrence
Apply knowledge of medical coding and billing to ensure accurate and efficient claims processing
Review and analyze complex claim documentation, assess policy coverage and claim validity, collaborate with internal and external stakeholders, and contribute to process improvement initiatives
Identify potential risks and issues that could impact health plan operations success and develop mitigation plans to address them proactively
Ensure that program deliverables meet quality standards and comply with relevant healthcare regulations and best practices
Implement change management strategies to address resistance and ensure smooth transitions during program implementation
Qualification
Required
5+ years in healthcare operations
3+ years reviewing medical claims
Knowledge of provider reimbursement methodologies
Bachelor's degree preferred/specialized training/relevant professional qualification
Preferred
QNXT claims experience
Claims editing
Knowledge of healthcare billing standards and code sets
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access and many other benefits depending on eligibility.
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
2026-01-25
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