Senior Director, UM Policy & Process Governance

CVS Health; Hartford (CT); On-site; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus program

Equity awards

Comprehensive benefits

Job summary

CVS Health is seeking a Lead Director, UM Center of Excellence (UM COE) to drive enterprise governance of Utilization Management content and resources across Commercial, Medicare, Medicaid, and other lines. You will ensure policies, procedures, letters, and forms are accurate, current, and compliant, collaborating with operations and enterprise stakeholders.

You will chair governance forums, lead content development and maintenance, and translate regulatory requirements into practical frontline

Qualifications

• 10-15 years of progressive experience in healthcare operations, Utilization Management, or policy administration.
• Demonstrated leadership of enterprise policy, procedure, workflow, or content governance.
• Deep understanding of UM operations and related policies, workflows, and frontline execution.
• Experience with CMS/NCQA regulatory and accreditation expectations.
• Strong analytical capabilities using metrics, dashboards, and audit findings.
• Exceptional executive communication and stakeholder engagement skills.

Responsibilities

• Set strategy, operating model, standards, and priorities for UM policy and process governance across Commercial, Medicare, Medicaid, Duals, and other supported lines.
• Lead development, review, approval, publication, maintenance, and annual review of UM policies, procedures, desktops, job aids, templates, letters, and forms.
• Ensure policies clearly define UM responsibilities and translate policy into structured workflows.
• Chair governance forums for business content and job aids, with defined roles and escalation paths.
• Oversee governance for content repositories, including release discipline and lifecycle management.
• Oversee intake and impact assessment for requests affecting UM documents and workflows.
• Collaborate with Legal, Compliance, NCQA, Training, Communications, Technology, and other teams to maintain compliant guidance.
• Provide consultation on system enhancements and operational changes affecting UM workflows and templates.

Skills

Utilization Management

Policy governance

Executive communication

Leadership

Stakeholder engagement

Education

Bachelor's degree or equivalent

Job description

CVS Health is seeking a Lead Director, UM Center of Excellence (UM COE) to drive enterprise governance of Utilization Management content and resources across Commercial, Medicare, Medicaid, and other lines. You will ensure policies, procedures, letters, and forms are accurate, current, and compliant, collaborating with operations and enterprise stakeholders.

You will chair governance forums, lead content development and maintenance, and translate regulatory requirements into practical frontline