Remote Manager, Medical Policy Analytics & Insights

CVS Health; Michigan; Hybrid; USD 54,000 - 146,000; Full time

Job summary

CVS Health is seeking a Manager, Medical Policy Business Analytics to lead analytics, reporting, and performance measurement for Medical Policy and Payment Integrity. You will translate healthcare and policy data into actionable insights to inform decisions and strengthen compliance.

You will partner with Clinical Operations, Medical Policy, Technology, Finance, and Quality teams to deliver data-driven recommendations, build dashboards, validate data, and monitor KPIs.

Qualifications

• Minimum 5 years of experience in healthcare analytics, business intelligence, medical policy, payment integrity, or related healthcare functions.
• Minimum 2 years of experience leading or coordinating projects, analytical workstreams, reporting initiatives, or cross-functional business activities.
• Advanced analytical, quantitative, and problem-solving skills leveraging AI.
• Experience developing executive dashboards, scorecards, KPIs, and performance reporting.
• Experience performing trend analysis, forecasting, root cause analysis, and performance measurement.
• Ability to communicate complex analytical concepts to technical and non-technical audiences.

Responsibilities

• Manage the development and maintenance of performance reporting for Medical Policy, Payment Integrity, and related operational programs.
• Develop, maintain, and monitor scorecards, KPIs, and trend analyses.
• Analyze policy performance, utilization patterns, coding trends, financial outcomes, and operational effectiveness.
• Identify opportunities to improve affordability, quality, and operational efficiency through data-driven insights.
• Prepare clear summaries, dashboards, and presentation materials for leadership review.
• Oversee the design, development, automation, and maintenance of dashboards, scorecards, and analytical reporting solutions.
• Provide subject matter input on reporting and BI tools and support consistent use of reporting standards.
• Partner with data management and technology teams to improve data accessibility and reporting capabilities.
• Support delivery of accurate, timely, and actionable reporting for business partners and leadership stakeholders.
• Promote self-service analytics and reporting capabilities where appropriate.
• Monitor policy adherence, implementation effectiveness, and compliance with internal controls and regulatory requirements.
• Support policy governance committees through reporting, trend analysis, and metric development.
• Partner with Quality Assurance and Compliance teams to identify and mitigate operational risks.
• Support internal audits, regulatory reviews, corrective action plans, and remediation efforts.
• Conduct root cause analyses to identify drivers of defects, policy exceptions, rework, and operational inefficiencies.
• Support continuous improvement initiatives targeting quality enhancement, defect reduction, and process optimization.
• Develop performance improvement recommendations supported by quantitative analysis.
• Measure and monitor outcomes associated with process improvement initiatives.
• Partner with business stakeholders to gather and document reporting, analytics, and operational requirements.
• Support BRD development and translation of business needs into technical solutions.
• Support strategic initiatives, system implementations, and transformation efforts by providing analytics, reporting, and business requirements input.
• Ensure analytics solutions align with business objectives and operational priorities.
• Coordinate cross-functional workgroups, projects, and analytical initiatives to support business objectives.
• Present insights, risks, trends, and recommendations to business leaders and cross-functional stakeholders.
• Provide consultative support regarding healthcare analytics, reporting methodologies, and performance measurement approaches.
• Build strong partnerships across clinical, operational, technology, compliance, and finance organizations.
• Support reporting standards and data governance practices.
• Ensure data integrity, consistency, and reliability across analytics platforms.
• Support data validation, quality monitoring, and issue remediation activities.
• Maintain documentation related to reporting methodologies, metric definitions, and data sources.

Skills

Healthcare analytics

BI dashboards

Data visualization

SQL

Power BI

Tableau

Excel

Machine learning basics

Stakeholder management

Project coordination

Education

Bachelor's Degree or equivalent experience

Tools

Power BI

Tableau

SQL

SAS

Snowflake

Azure Analytics

Job description

CVS Health is seeking a Manager, Medical Policy Business Analytics to lead analytics, reporting, and performance measurement for Medical Policy and Payment Integrity. You will translate healthcare and policy data into actionable insights to inform decisions and strengthen compliance.

You will partner with Clinical Operations, Medical Policy, Technology, Finance, and Quality teams to deliver data-driven recommendations, build dashboards, validate data, and monitor KPIs.