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Bringing our heart to every moment of your health.
Manager, Program Management
Location
Kentucky + 3 moreAll locations: Kentucky | Ohio | Oklahoma | Texas
Posted
119 days ago
Salary
$54.3K - $119.3K / year
Seniority
Senior
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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