Senior Director, UM Policy & Process Governance

4062 Aetna Resources, LLC; United States; Remote; USD 100,000 - 232,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Job summary

CVS Health in the United States is seeking a Lead Director, UM Center of Excellence (UM COE) to drive enterprise governance of UM policies, templates, letters and related content across Commercial, Medicare, Medicaid, and other lines of business.

You will chair governance forums, guide content development, align requirements with regulatory and contractual needs, and partner with Operations, Legal, Compliance, and Training to ensure frontline teams have clear, usable guidance.

Qualifications

• 10–15 years in healthcare operations, utilization management, policy administration, or related fields.
• Experience leading enterprise policy and content governance in regulated environments.
• Strong understanding of UM operations and regulatory/accreditation expectations (CMS, NCQA, Medicaid).
• Proven ability to establish governance models and drive cross-functional decision-making.
• Analytical skills using metrics, dashboards, audit findings, and stakeholder feedback.
• Excellent executive communication, stakeholder engagement, influence, negotiation, and issue-resolution skills.

Responsibilities

• Set strategy, operating model, standards, and priorities for UM policy governance across Commercial, Medicare, Medicaid, Duals, and other supported lines of business.
• Lead development, review, approval, publication, maintenance, and annual review of UM policies, procedures, Medicaid policy amendments, desktops, job aids, documentation templates, UM letters, and fax forms.
• Ensure policies and procedures clearly define UM responsibilities, translate policy into structured workflows, and are formatted to support regulatory submission, licensure, accreditation, audit, and contractual requirements.
• Chair and mature governance forums for business content and job aids, establishing clear roles, decision rights, approval pathways, escalation practices, and accountability across participating functions.
• Own governance for the CS Hub and related content repositories, including release discipline, content quality, searchability, standard formatting, version control, and lifecycle management.
• Oversee intake and impact assessment for requests affecting UM documents and workflows, including operational changes, policy updates, regulatory or accreditation requirements, audit findings, corrections, questions, and system-related changes.
• Direct evaluation of current-state and future-state requirements, determine affected content and downstream impacts, and ensure updates receive appropriate stakeholder review and sign-off before publication.
• Partner with UM Operations, Medical Affairs, Legal, Compliance, NCQA, Quality and Audit, Training, Communications, Technology/DDAT, and other enterprise teams to maintain consistent, compliant, and usable guidance.
• Provide consultation on system enhancements and operational changes that affect UM workflows, documentation requirements, decision support, templates, letters, or content repositories.
• Establish and monitor performance measures for governance effectiveness, including intake volume, turnaround time, backlog, defects, compliance incidents, annual-review completion, adoption, usability, and release activity.
• Use data and stakeholder feedback to identify content gaps, simplify and standardize guidance, improve readability and usability, reduce defects, and strengthen the connection between policy and frontline execution.
• Ensure approved changes are communicated to impacted stakeholders and coordinated with operational readiness, training, communications, and audit partners as appropriate.
• Lead post-publication monitoring and continuous improvement to confirm content remains accurate, adopted, and responsive to evolving business, regulatory, and operational needs.
• Lead, coach, and develop a multidisciplinary team responsible for policy management, business content management, job aid and workflow governance, documentation templates, letters, forms, and intake support.
• Foster a culture of accountability, collaboration, disciplined governance, customer focus, and continuous improvement within the Policy & Process Governance team.

Skills

Strategic leadership

Governance & policy management

Cross-functional collaboration

Data analytics & metrics

Executive communication

Project management

Regulatory compliance knowledge

Education

Bachelor's degree or equivalent

Advanced degree or healthcare administration/operations/public health

Job description

CVS Health in the United States is seeking a Lead Director, UM Center of Excellence (UM COE) to drive enterprise governance of UM policies, templates, letters and related content across Commercial, Medicare, Medicaid, and other lines of business.

You will chair governance forums, guide content development, align requirements with regulatory and contractual needs, and partner with Operations, Legal, Compliance, and Training to ensure frontline teams have clear, usable guidance.