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 project manager who will use critical thinking skills to support the Commercial, Medicare, Duals and Medicaid policy and procedure review process; develop and implement strategies to support UM transformation activities and manage desktops, job aids, tools and resources.

This position is part of the UM COE, Program Design & Implementation team that is responsible Clinical Services utilization management and specialty program policies & procedures. Primary responsibilities of this position include: the support of Commercial, Medicare, and Medicaid policies and Medicaid state amendments, Duals policies, drafting/leading the implementation of changes that impact workflows that clinical teams use; support of the UM organization (precertification, predetermination, acute inpatient and post-acute inpatient review) through the development and maintenance of workflows, tools and supporting materials.

Responsibilities include the management commercial, Medicare and Medicaid desktops, job aids and documentation templates. The development of tools and resources to support existing and newly designed processes/program changes. The ability to identify efficiencies, respond to field inquiries and project manage process changes including ensuring that all project deliverables and due dates are met while focusing on quality are all components of this position. Must be able to address system interface, accrediting body requirements and collaborate across appropriate organizations during the design of newly identified processes. Support of system enhancements. The ability to conceptualize changes and contribute to system projects that impact UM staff is critical. Must be able to represent the team during project discussions. Serves as a subject matter expert during cross-functional project implementations.

The candidate must have excellent communication skills as this position requires verbal presentations and writing of policy/process documents. Some experience in giving verbal presentations and formal writing would be ideal.
Requires extensive collaboration with all levels of UM staff from Medical Directors to front line staff thus, management experience is critical.
Project management experience preferred. Ideally, the candidate will have led project teams to implementation but, if not, project participation and meeting assigned project deliverables is sufficient.

Required Qualifications

3 years minimum of utilization management experience required

Preferred Qualifications
Project Management Certification, preferred

3 years minimum of supervisory experience required

Education

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $119,340.00

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: 03/30/2025

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