Senior Manager, Appeals Project Program Manager

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.

The Medicare PAR Provider Appeals organization is crucial to addressing providers issues promptly and efficiently. The Medicare appeals team is seeking a self-motivated and detail-oriented Senior Manager to join our team. As the Senior Manager, Complaint & Appeals (Medicare) you will have a demonstrated ability to work in a highly matrixed organization with proven success in such an environment.  Will manage Appeals projects including Provider Experience initiatives.

You will be responsible for driving internal projects and product capabilities from initiation execution.  This candidate will collaborate and communicate across business partners and maintain project documentation supporting measurement and evaluation of projects, fostering collaboration with stakeholders, and driving continuous learning and skill development within the team.

Key Responsibilities:

• Drive strategic initiatives and explore future opportunities that align with Aetna’s vision, ensuring the appeals team remains innovative and competitive. Develop and manage project plans, define key deliverables and deadlines and establish iterative project milestones.
• Prepare and deliver executive reporting and proactive tools to provide insights into program performance, quality monitoring and strategic initiatives. 
• Effective communication with Network, finance, and other internal stakeholders on progress of key initiatives, opportunities/risks
• Evaluating process improvement opportunities while also ensuring seamless business support and people-first approach to change management
• Development of high performing strategy and execution teams that work effectively with other parts of the business and with suppliers and external supply chain partners to meet business targets

For this role you will need Minimum Requirements

• 5+ years of relevant work experience
• Project Management: Demonstrated experience in program and project management, with a proven ability for problem solving and decisions making when leading complex initiatives from conception to execution.
• Industry Experience: Experience in health insurance/healthcare, clinical policy, claims, Utilization management, Clinical Claim Review or Appeals, providing well-rounded perspective on strategic initiatives.
• Execution and delivery: Proficient in execution and delivery of projects (planning, delivering and risk mitigation)
• Presentation Skills: Proficient in creating impactful presentations, with the ability to effectively communicate ideas and strategies to diverse audiences.

Education

• Bachelor's degree or equivalent work experience.

Ideal Candidate Attributes

• Organized and Forward-Thinking: Highly organized, with a forward-thinking mindset and a curiosity to explore new ideas and solutions.
• Influential Leader: Ability to influence outcomes in a matrix environment, fostering collaboration and alignment across diverse teams.
• Emotional Intelligence: Demonstrates a high degree of emotional intelligence in interactions, leading with empathy and understanding.
• Positive Team Culture: Actively contributes to a positive, growth-oriented team culture, encouraging collaboration and innovation.

Pay Range

The typical pay range for this role is:

$67,900.00 - $199,144.00

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: 04/20/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.