At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Multifunctional program manager who will use critical thinking skills to review, assess impact and implement State and Federal Regulations, develop, and implement strategies to support Legislative and Regulatory changes. This colleague will work with legal, compliance and utilization management stakeholders to support legal mandate/compliance changes & audits as well as provide consultative support & clarification of implemented mandates. They will ensure that all appropriate document updates are current and accurate. This role requires a colleague who is comfortable working across multiple departments.

Fundamental Components Include but are not Limited to:This position is part of the Utilization Management Center of Excellence, a team that is responsible for Clinical Services utilization management and specialty program policies/proceduresPrimary responsibilities of this position include: The review and implementation of State and Federal Regulations across all lines of business (Commercial, Medicare, Medicaid)Review of policy, job aids and workflows that support regulatory requests, drafting/leading implementation of regulatory changes

Strategic Goals and ResponsibilitiesDevelop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna.Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.Develop and implement strategy for policy/program development that considers all involved areas (e.g., systems, actuarial, marketing etc.) and the potential impact on all managed care products.Operationalize strategy by prioritizing projects, designing programs, developing policies.Identify and involve appropriate subject matter experts (those who will operationalize programs).Design/manage implementation including business processes, system, and other modifications.Design/manage communications and training.Analyze ongoing performance data, utilize and initiate/implement changes.

Required Qualifications
3+ years minimum of utilization management - Clinical Operations experience

3+ Experience & knowledge of Medicare & CMS compliance  

3+ Experience in implementing new programs/changes in UM space

Preferred Qualifications

Knowledge of Commercial, Medicare, Medicaid, Duals LOB
RN license preferred

PMP Certification

Education Bachelor's degree or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 09/01/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.