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CVS Health logo
CVS Health

Bringing our heart to every moment of your health.

Manager, Program Management

Program ManagerProgram ManagerOtherRemoteSeniorTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

Kentucky + 3 moreAll locations: Kentucky | Ohio | Oklahoma | Texas

Posted

119 days ago

Salary

$54.3K - $119.3K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

Manager, Program Management

CVS Health

• Facilitate successful implementation of Medicaid health plan operations programs by coordinating with cross-functional teams • Enhance operational efficiency, ensure compliance with regulatory standards, and contribute to overall healthcare operations success • Assist in the management of stakeholder relationships and establish communication channels regarding claims payment, contract or benefit setup • Collect, analyze, and interpret operational data to identify trends and insights for decision-making and improvements • Analyze operational issues, provider complaints, and propose solutions • Apply knowledge of medical coding and billing to ensure accurate claims processing • Review and analyze complex claim documentation and assess policy coverage • Identify potential risks that could impact health plan operations and develop proactive mitigation plans • Ensure program deliverables meet quality standards and comply with relevant regulations and best practices • Implement change management strategies during program implementation

Job Requirements

  • 5+ years in healthcare operations
  • 3+ years reviewing medical claims
  • Knowledge of provider reimbursement methodologies
  • QNXT claims experience
  • Claims editing
  • Knowledge of healthcare billing standards and code sets
  • Bachelor's degree preferred/specialized training/relevant professional qualification

Benefits

  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs including wellness screenings, tobacco cessation and weight management programs
  • Confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

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