Manager, Project Management - Prior Authorization

CVS Health•Work At Home-Pennsylvania, MA

22h•$60,300 - $132,600

About The Position

This individual contributor is responsible for project management, operational coordination, and production support of Prior Authorization and Referral transactions and provider-facing workflows. The role is a key liaison among business, technology, production support, and external partners, managing project deliverables, supporting transaction-related issue resolution, coordinating testing and implementation, and helping ensure reliable provider experiences. The position is a primary point of contact for Production Support ticket issues, coordinating investigation, tracking issues through resolution, and identifying process and workflow improvements. It also supports roadmap initiatives, enhancements, release readiness, and business requirements, translating provider and operational needs into actionable project deliverables.

Requirements

5–7 years of healthcare-related work experience.
Experience supporting Authorization and Referral workflows, preferably in payer, provider, EDI, or healthcare transaction environments.
Demonstrated project management experience coordinating work across business and technology teams.
Experience with production issue management, including investigation, triage, escalation, root-cause identification, and coordination through resolution.
Experience supporting requirements gathering, business testing, implementation, and post-production activities.
Strong analytical, problem-solving, and decision-making skills.
Strong collaboration and teamwork skills, with the ability to coordinate across multiple business and technology stakeholders.
Strong written and verbal communication skills, including the ability to translate technical or transaction-related issues into clear business language.
Ability to manage multiple priorities, project deliverables, and production issues in a fast-paced environment.
Demonstrated growth mindset, adaptability, and willingness to develop deeper expertise in Prior Authorization and Referral capabilities.

Nice To Haves

Bachelor’s degree in Business Administration, Healthcare Administration, Information Systems, Project Management, or a related field preferred.

Responsibilities

Manage and coordinate projects and enhancements supporting Prior Authorization and Referral transactions, workflows, and provider experiences.
Serve as a primary point of contact for Production Support ticket issues, coordinating investigation, escalation, tracking, and resolution with appropriate business and technology partners.
Partner with business, technology, EDI, interoperability, and other stakeholders to investigate and resolve transaction- and workflow-related issues.
Coordinate project activities, including requirements gathering, documentation, milestone tracking, risk and issue management, testing, implementation readiness, and post-production support.
Analyze Prior Authorization and Referral transaction behavior and provider workflows to identify root causes, recurring issues, and opportunities for improvement.
Coordinate business testing for system enhancements and releases, including test scenario development, defect management, validation, and implementation support.
Translate business and provider needs into clear requirements and work with technology partners to support solution delivery.
Monitor project deliverables, dependencies, risks, and outstanding decisions, and proactively escalate items that could affect delivery or the provider experience.
Support intake and prioritization of enhancements, defects, and roadmap opportunities impacting Prior Authorization and Referral capabilities.
Develop and maintain project and workflow documentation, status reporting, issue tracking, and stakeholder communications.
Facilitate cross-functional meetings and working sessions to drive decisions, remove blockers, and ensure clear ownership of deliverables.
Support implementation and post-release monitoring to validate expected outcomes and identify production issues.
Serve as an operational and project resource for continuous improvement of Prior Authorization and Referral transaction capabilities and provider-facing workflows.