Senior Manager, Policy & Experience Optimization

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

Benefits offered by this job

Bonus eligibility

Equity award program

Job summary

CVS Health Corporation seeks a Senior Manager to lead MPPS Experience Optimization, leveraging analytics to improve medical and payment policy effectiveness and the provider experience. You will drive cross-functional initiatives, translate insights into actionable recommendations, and reduce administrative burden while delivering measurable improvements.

Responsibilities include strategic leadership for optimization programs, governance, and partnering with analytics, policy, and clinical teams

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.
• Demonstrated 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.
• Leverage data to identify trends, friction points, and opportunities for improvement across claims and policy lifecycles.
• Establish approaches and measures to advance optimization opportunities from analysis to implementation and measurement.
• Provide strategic leadership for experience optimization programs and maintain a prioritized portfolio of opportunities.
• Partner with analytics and technology teams to develop reporting and insights into policy performance and outcomes.
• Lead cross-functional evaluation of complex policy opportunities and translate findings into clear recommendations and outcomes.

Skills

Policy optimization

Healthcare analytics

Leadership

Stakeholder management

Data-driven decision making

Communication

Cross-functional collaboration

Education

Bachelor’s degree in healthcare administration, business, public health, health informatics, nursing, analytics, or related field

CPC/CCS/RHIT or equivalent credential (required or within 1 year)

Job description

CVS Health Corporation seeks a Senior Manager to lead MPPS Experience Optimization, leveraging analytics to improve medical and payment policy effectiveness and the provider experience. You will drive cross-functional initiatives, translate insights into actionable recommendations, and reduce administrative burden while delivering measurable improvements.

Responsibilities include strategic leadership for optimization programs, governance, and partnering with analytics, policy, and clinical teams