Senior Manager, Health Policy & Experience Optimization

CVS Health Corporation; United States; Remote; USD 68,000 - 183,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Equity award program

Job summary

CVS Health is seeking a Senior Manager MPPS Experience Optimization to lead data-driven strategies that improve medical and payment policy effectiveness and the provider experience. This role leverages claims, appeals, coding, reimbursement, provider experience, and operational insights to identify optimization opportunities and drive measurable improvement.

You will partner with analytics, clinical, coding, payment integrity, claims, appeals, provider, compliance, operations, and technology

Qualifications

• 5+ years of experience in healthcare, medical or payment policy, payment integrity, coding, claims, appeals, healthcare analytics, provider experience, or related healthcare functions.
• Supervisory or formal people-leadership experience required.
• Experience using multiple data sources to identify trends, performance gaps, and optimization opportunities and translate findings into actionable recommendations.
• Strong knowledge of healthcare reimbursement, claims processing, medical and/or payment policy, and coding concepts, including CPT, HCPCS, and ICD-10.
• Experience leading complex, cross-functional initiatives from analysis and recommendation through implementation and measurement.
• Demonstrated ability to communicate complex findings, influence decision-making, and collaborate effectively across a matrixed organization.
• Strong strategic thinking, analytical problem-solving, communication, and stakeholder-management skills.

Responsibilities

• Develop and execute strategies to identify, evaluate, prioritize, and advance medical and payment policy optimization opportunities.
• Lead cross-functional initiatives using analytics, clinical, coding, and provider data to identify trends, friction points, and opportunities for improvement.
• Evaluate and modernize policies to improve clarity, consistency, effectiveness, and applicability across the claims lifecycle, including both pre-payment and post-payment use.
• Develop evidence-based recommendations that balance policy intent, clinical and coding standards, provider experience, compliance, and business impact.
• Establish consistent approaches and performance measures to advance optimization opportunities from analysis through implementation and measurement.
• Provide strategic leadership for experience optimization programs and maintain a prioritized portfolio of opportunities aligned with enterprise objectives.
• Partner across medical policy, clinical, coding, payment integrity, claims, appeals, provider, compliance, operations, analytics, technology, and other key functions.

Skills

Healthcare analytics

Policy optimization

Cross-functional leadership

Data-driven decision making

Strategic thinking

Communication & stakeholder mgmt

Education

Bachelor's degree in healthcare or related field

Healthcare credential (CPC/CCS/RHIT or equivalent)

Job description

CVS Health is seeking a Senior Manager MPPS Experience Optimization to lead data-driven strategies that improve medical and payment policy effectiveness and the provider experience. This role leverages claims, appeals, coding, reimbursement, provider experience, and operational insights to identify optimization opportunities and drive measurable improvement.

You will partner with analytics, clinical, coding, payment integrity, claims, appeals, provider, compliance, operations, and technology