Senior Manager Business Analysis

CVS Health; United States; Remote; USD 67,000 - 150,000; Full time

Job summary

A leading health solutions company seeks a Senior Business Analyst to translate business needs into high-quality requirements, ensuring compliance with CMS regulations. The role requires collaboration with various teams and mentoring junior analysts. Candidates should have extensive experience with FHIR and CMS compliance.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Financial coaching

Flexible work schedules

Tuition assistance

Qualifications

• 7+ years of experience with CMS Interoperability compliance regulations.
• 3+ years of experience with Fast Healthcare Interoperability Resources (FHIR).
• 2+ years of experience in the healthcare industry.

Responsibilities

• Translate business needs to create high-quality requirements.
• Ensure compliance with CMS and state Interoperability regulations.
• Mentor junior business analysts.

Skills

Collaboration

Strategic Thinking

Education

Bachelor’s degree

Tools

Google Cloud Platform

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
The Senior Business Analyst will translate business needs to create high-quality requirements. A significant requirement for this position will be to translate CMS and state Interoperability compliance regulations and have a strong understanding of Fast Healthcare Interoperability Resources (FHIR) to perform source to target (FHIR) mapping. Expectation for the Senior Business Analyst will be to ensure 100% adherence to all CMS and state Interoperability compliance regulations in advance of the specified due dates.

As a Senior Business Analyst, fostering a strong collaborative environment within your team and with Interoperability business leadership, architecture, partner teams, and other organizations, will be critical to success. The Senior Business Analyst will also be expected to perform occasional mentoring of new, junior business analysts as they join the team.

As a Senior Business Analyst, you will:

• Study, understand and translate Interoperability consortium guidelines to successfully map numerous CVS Health data sources to FHIR data store
• Translate business needs to create high-quality requirements
• Ensure successfully delivery of key Prior Authorization and Provider Access functionality as mandated by the significant CMS 0057-f mandate, the additional new state compliance mandates, as well as the emerging non-compliance initiatives that bring significant value to Aetna, our members, providers and the entire healthcare industry
• Ensure that all compliance requirements are delivered successfully, before the mandated deadlines.
• Mentor junior business analysts that are added to the team
• Collaborate with Interoperability business product owners and managers to understand their priorities, problems, and goals
• Apply an understanding of the Company’s business, building strong and sustainable relationships, and interacting with all levels of the organization

Required Qualifications:

• 7+ years of experience with the CMS Interoperability compliance regulations
• 3+ years of experience with Fast Healthcare Interoperability Resources (FHIR)
• 3+ years of experience working on delivery teams dedicated to compliance of all CMS and state Interoperability regulations
• 2+ years of experience of the healthcare industry and how it functions
• 2+ years of experience mentoring new, junior members that are added to the team
• 1+ years of experience working with Google Cloud Platform (GCP) FHIR stores

Preferred Qualifications:

• Must demonstrate strategic thinking as well as a “roll up your sleeves” action
• Experience with enterprise cross-functional initiatives, with a high degree of complexity
• Ability to collaborate with and understand the needs of senior business leaders and translate those needs to an actionable plan
• Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias

Education:

• Bachelor’s degree or equivalent experience (Highschool diploma plus 4 years relevant work experience.)

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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
The Senior Business Analyst will translate business needs to create high-quality requirements. A significant requirement for this position will be to translate CMS and state Interoperability compliance regulations and have a strong understanding of Fast Healthcare Interoperability Resources (FHIR) to perform source to target (FHIR) mapping. Expectation for the Senior Business Analyst will be to ensure 100% adherence to all CMS and state Interoperability compliance regulations in advance of the specified due dates.

As a Senior Business Analyst, fostering a strong collaborative environment within your team and with Interoperability business leadership, architecture, partner teams, and other organizations, will be critical to success. The Senior Business Analyst will also be expected to perform occasional mentoring of new, junior business analysts as they join the team.

As a Senior Business Analyst, you will:

• Study, understand and translate Interoperability consortium guidelines to successfully map numerous CVS Health data sources to FHIR data store
• Translate business needs to create high-quality requirements
• Ensure successfully delivery of key Prior Authorization and Provider Access functionality as mandated by the significant CMS 0057-f mandate, the additional new state compliance mandates, as well as the emerging non-compliance initiatives that bring significant value to Aetna, our members, providers and the entire healthcare industry
• Ensure that all compliance requirements are delivered successfully, before the mandated deadlines.
• Mentor junior business analysts that are added to the team
• Collaborate with Interoperability business product owners and managers to understand their priorities, problems, and goals
• Apply an understanding of the Company’s business, building strong and sustainable relationships, and interacting with all levels of the organization

Required Qualifications:

• 7+ years of experience with the CMS Interoperability compliance regulations
• 3+ years of experience with Fast Healthcare Interoperability Resources (FHIR)
• 3+ years of experience working on delivery teams dedicated to compliance of all CMS and state Interoperability regulations
• 2+ years of experience of the healthcare industry and how it functions
• 2+ years of experience mentoring new, junior members that are added to the team
• 1+ years of experience working with Google Cloud Platform (GCP) FHIR stores

Preferred Qualifications:

• Must demonstrate strategic thinking as well as a “roll up your sleeves” action
• Experience with enterprise cross-functional initiatives, with a high degree of complexity
• Ability to collaborate with and understand the needs of senior business leaders and translate those needs to an actionable plan
• Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias

Education:

• Bachelor’s degree or equivalent experience (Highschool diploma plus 4 years relevant work experience.)

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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. This position also includes an award target in the company’s equity award program.

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: 05/26/2025

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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