Director, UM Policy & Process Governance COE

CVS Health; Raleigh (NC); On-site; USD 100,000 - 232,000; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off

Retirement options

Wellness programs

Equity awards

Job summary

CVS Health is seeking a Lead Director, UM Center of Excellence (Policy & Process Governance) to lead enterprise governance of UM content and resources. You will shape standards, drive publication and maintenance of policies, and partner with Operations, Legal, Compliance, and Quality to deliver compliant, usable guidance across lines of business.

You will chair governance forums, oversee content repositories, and steer ongoing improvements to ensure policies meet regulatory, accreditation, and

Qualifications

• 10–15 years of progressive healthcare operations experience, preferably within UM or managed care.
• Leadership of enterprise policy and content governance in a regulated environment.
• Deep understanding of UM operations and CMS/NCQA expectations.
• Experience establishing governance models and cross-functional decision making.
• Strong analytical skills with metrics, dashboards, and audit findings.
• Executive communication and stakeholder influence to drive change.

Responsibilities

• Set strategy, operating model, standards, and priorities for UM policy governance.
• Lead development, review, publication, and annual update of UM policies and related content.
• Ensure policies translate to structured workflows and support regulatory/contractual needs.
• Chair governance forums and establish roles, approvals, and accountability.
• Own governance for content repositories, release discipline, and lifecycle management.
• Oversee intake and impact assessment for content and workflow changes.
• Collaborate with multiple enterprise teams to maintain compliant guidance.
• Provide consultation on system enhancements affecting UM workflows and templates.
• Monitor performance measures like intake, turnaround, backlog, and adoption.

Skills

Healthcare operations

Utilization Management

Policy governance

Leadership

Analytics

Executive communication

Education

Bachelor's degree

Advanced degree in healthcare administration

Job description

CVS Health is seeking a Lead Director, UM Center of Excellence (Policy & Process Governance) to lead enterprise governance of UM content and resources. You will shape standards, drive publication and maintenance of policies, and partner with Operations, Legal, Compliance, and Quality to deliver compliant, usable guidance across lines of business.

You will chair governance forums, oversee content repositories, and steer ongoing improvements to ensure policies meet regulatory, accreditation, and