Manager, Clinical Services

CVS Health; United States; Remote; USD 60,000 - 146,000; Full time

Job summary

CVS Health is seeking an Advanced Level Program Position to provide strategic support in technology for operations management. This role involves managing teams, problem resolution, and ensuring compliance with regulatory standards. Candidates should have significant experience, strong Microsoft 365 skills, and a proven leadership track record. Join a dedicated team committed to transforming healthcare for millions across the nation.

Qualifications

• 5+ years of relevant work experience.
• Demonstrated success in leadership role.
• Experience with prior authorization systems.

Responsibilities

• Manage CGSO Incident Management for various systems.
• Lead technical product SME teams.
• Coordinate problem analysis and solution validation.

Skills

Microsoft 365

Verbal Communication

Written Communication

Problem Identification

Technical Solutioning

Team Efficiency Management

Education

Bachelor's degree

Job description

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

This is an advanced level program position that will be responsible for providing strategic technology support and direction to operations management and leadership teams.

• Own CGSO Incident Management for CAS, MHK and Novologix (NLX) prior authorization systems, as well as CRxM Pharmacy Advisor applications.
• Lead a dynamic team of technical product SMEs.
• Coordinate problem analysis, solution validation, risk management, issue resolution/escalation, communication, and stakeholder engagement for all technology initiatives.
• Responsible for integration and coordination of changes across upstream product and IT teams and downstream operational teams.
• Appropriately identifying problems, challenges, risks and impacts for any change or enhancement being proposed and problem solving to ensure optimal Operational performance.
• Drive improvements through incident management, but also in collecting an understanding of best practices in each business unit and streamlining all business units to adopt these best practices.
• Responsible for working closely with stakeholders and business partners to manage application incidents and impacts during product releases.
• Interface and communicate directly with Senior and Executive leadership from all different areas of the company and interface heavily with IT development partners.
• Operate with a high level of flexibility to meet the demands of a production environment, regulatory/accreditation landscape, and client customization to ensure our technology supports the operational expense, client savings, and compliance goals. Must ensure compliance with all appropriate regulations – Federal and State, accreditation standards – URAC and NCQA, client requirements, and performance guarantees, especially as it relates to technology functionality.

Required Qualifications

*5+ years of relevant work experience

*Demonstrated success in leadership role.

*2+ years experience building executive level deliverables.

*Strong Microsoft 365 (including Word, Excel, PowerPoint, and SharePoint skills)

*Excellent verbal and written communication skills.

*Experience working efficiently and effectively in a cross-functional team setting with colleagues from multiple business segments and levels.

*Understand complex problems, identify technical solutions, and define business requirements to support the solution.

*Experience ensuring team efficiency.

*Experience with prior authorization systems

Preferred Qualifications
*Healthcare, insurance, or pharmacy experience

*Formal operational experience with CAS, Novologix, MHK, Pharmacy Advisor *products.

*Experienced handling product incident management.

*Experienced working through ambiguity and influencing others for buy-in.

Education
Bachelor's degree or relevant job experience required.

Anticipated Weekly Hours

40

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

This is an advanced level program position that will be responsible for providing strategic technology support and direction to operations management and leadership teams.

• Own CGSO Incident Management for CAS, MHK and Novologix (NLX) prior authorization systems, as well as CRxM Pharmacy Advisor applications.
• Lead a dynamic team of technical product SMEs.
• Coordinate problem analysis, solution validation, risk management, issue resolution/escalation, communication, and stakeholder engagement for all technology initiatives.
• Responsible for integration and coordination of changes across upstream product and IT teams and downstream operational teams.
• Appropriately identifying problems, challenges, risks and impacts for any change or enhancement being proposed and problem solving to ensure optimal Operational performance.
• Drive improvements through incident management, but also in collecting an understanding of best practices in each business unit and streamlining all business units to adopt these best practices.
• Responsible for working closely with stakeholders and business partners to manage application incidents and impacts during product releases.
• Interface and communicate directly with Senior and Executive leadership from all different areas of the company and interface heavily with IT development partners.
• Operate with a high level of flexibility to meet the demands of a production environment, regulatory/accreditation landscape, and client customization to ensure our technology supports the operational expense, client savings, and compliance goals. Must ensure compliance with all appropriate regulations – Federal and State, accreditation standards – URAC and NCQA, client requirements, and performance guarantees, especially as it relates to technology functionality.

Required Qualifications

*5+ years of relevant work experience

*Demonstrated success in leadership role.

*2+ years experience building executive level deliverables.

*Strong Microsoft 365 (including Word, Excel, PowerPoint, and SharePoint skills)

*Excellent verbal and written communication skills.

*Experience working efficiently and effectively in a cross-functional team setting with colleagues from multiple business segments and levels.

*Understand complex problems, identify technical solutions, and define business requirements to support the solution.

*Experience ensuring team efficiency.

*Experience with prior authorization systems

Preferred Qualifications
*Healthcare, insurance, or pharmacy experience

*Formal operational experience with CAS, Novologix, MHK, Pharmacy Advisor *products.

*Experienced handling product incident management.

*Experienced working through ambiguity and influencing others for buy-in.

Education
Bachelor's degree or relevant job experience required.

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: 06/20/2025

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

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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