Health Services Manager - Medical Policy & Program Solutions

CVS Health

8d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Manager, Health Services is a key member of the Medical Policy & Program Solutions Team. The Manager influences health care quality projects and initiatives through design, development, and implementation. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business units to meet business needs and accomplish goals. This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States. Leads the work and deliverables of multiple, complex programs, and supports new business initiatives, that impact multiple process, systems, functions, and products related to authorizations services. Develops and implements business plans to achieve business goals for Medical Policy & Program Solutions. Collaborates and partners with other functional managers, other business areas/across the segments or other business areas. Develops and implements innovative ideas that support work/teams. Assists others to identify solutions to issues that negatively impact program and/or project plan. Leads and supports scorable action items across Commercial, Medicare and/or nationally. Develops documentation templates and systems to support projects and initiatives.

Requirements

• Certified Professional Coder through AAPC or AHIMA (Physician, Facility or Payer) a plus or willing to pursue within two years.
• Knowledge of healthcare insurance and industry standards to include Medicare and Medicaid
• Minimum 3 years' Commercial, Medicare, and experience to include understanding of compliance regulations for Medicare
• Experience and participation in Commercial, Medicare, and internal audits and/or CMS audits – for example questions regarding incorrectly paid claims
• Proficiency in Microsoft Excel, Word, and Power Point

Nice To Haves

• Code editing and quality review experience related to payment policies, projects and programs.
• Clinical experience as an RN or LPN
• Experience with QuickBase applications ACAS and/or HRP
• Claim review and expertise
• Project management experience a plus or experience managing internal projects

Responsibilities

• Leads the work and deliverables of multiple, complex programs, and supports new business initiatives, that impact multiple process, systems, functions, and products related to authorizations services.
• Develops and implements business plans to achieve business goals for Medical Policy & Program Solutions.
• Collaborates and partners with other functional managers, other business areas/across the segments or other business areas.
• Develops and implements innovative ideas that support work/teams.
• Assists others to identify solutions to issues that negatively impact program and/or project plan.
• Leads and supports scorable action items across Commercial, Medicare and/or nationally.
• Develops documentation templates and systems to support projects and initiatives.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree