Senior Manager, Business Consulting

CVS Health•Work At Home-Connecticut, CT

2d•$82,940 - $182,549

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 Senior Manager - Business Consulting, within the Payment Integrity Center of Excellence (PICOE) team, will help formulate, lead, and champion strategic initiatives in partnership with vendor partners, senior leaders, internal stakeholders across the enterprise, and/or key business partners. Initiatives may range across operational change, new uses of analytics and technology, process standardization, enhanced customer service, and more. Length of project(s) may run multiple months or years in duration. This position will require continuous collaboration and consultation with vendor partners, leaders, contributors, and various level stakeholders to ensure the desired business outcome is defined and achieved. The ideal candidate is an initiative-taker, detail-oriented, highly organized, and able to work on multiple tasks simultaneously in a fast-paced and ever-changing environment. This role involves complex, cross-functional stakeholder management and significant exposure to leadership. It requires a strong background in complex program management, business or healthcare consulting, or strategic planning and process improvement, with demonstrated ability to work independently, build collaborative relationships, communicate clearly, gain alignment and consensus, build comprehensive execution plans, and meet difficult deliverables in a dynamic environment. It also requires openness to diverse and often ambiguous objectives, with a proven track record of facilitating and influencing teams, with and without authority. The Senior Manager, Business Consulting, supports the business by recommending appropriate actions, strategies and/or alternatives to meet healthcare industry business needs. The candidate should exhibit the ability to identify and manage project implementation activities across the enterprise that includes increasing the contractual terms, reimbursement accuracy and performance of our claim editing vendors, proposing opportunities to lowering G&A (reducing appeals, claim rework, and provider settlements), maximizing revenue, centralizing vendor data accuracies and service level agreements, and improving overall consistency and credibility of our Payment Integrity programs.

Requirements

5+ years related experience in project/program management, policy (financial analysis, forecasting and/or procurement/sourcing) associated with external Payment Integrity Vendors
5+ years of direct project/vendor management experience; managing medium-to-large-scale, cross-functional projects
Financial/Operational Metric and Performance Analysis and Vendor Contractual Acumen
Experience includes development and management of multiple projects and/or programs, simultaneously
Self-starter with the ability to work independently and effectively prioritize multiple deliverables
Demonstrated flexibility to manage conflicting priorities and multiple projects concurrently
Proven track record in meeting deadlines, assigned deliverables, project milestones, and negotiating for resources
Expert problem-solver who is an analytical critical-thinker with ability to execute remediation plans
Ability to influence, collaborate, and communicate effectively with all levels and varying audiences
Systems-thinker, willing to challenge the status quo, to generate innovative solutions, and drive change
Demonstrated success using verbal and written communication skills to present information

Nice To Haves

Ability to interact with others in a collaborative and professional manner while fostering teamwork and knowledge sharing to complete key tasks
Strong presentation and communication skills with experience presenting to various business groups
Aptitude to communicate complex findings and conclusions in an easy-to-understand way
Strong organizational, multi-tasking, and follow up skills
Ability to work independently in a fast-paced environment, manage tight deadlines, and competing priorities
Experience with Health Rules Payer (HRP), QNXT (Medicaid), Medcompass, ACAS transaction system(s)
Strong understanding of the various Aetna systems and the end-to-end provider/member experience operating model
Prior healthcare and/or project management experience
Project Management or Coder Certification(s) preferred

Responsibilities

Leads monthly invoice/payment reconciliation and associated metrics for vendor reimbursement
Acts as an advocate for change, influencing others to see the value in project and/or processes; driving innovative and realistic solutions that align to CVS Health’s strategic direction.
Manages the work and deliverables of multiple, complex projects or programs, through ideation to implementation; that impact multiple processes, systems, functions, services, and/or products.
Cohesive project facilitation, planning, collaboration, analysis, and guidance, ensuring that solutions achieve the expected business benefit or result.
Active participation in all phases of the program management processes: which may include discovery, assessment, initiation, planning, design, development, testing, execution, deployment, post implementation support etc.
Ensure business requirements are defined, documented, and interpreted to meet stakeholder interests; and successful delivery of project end-state that meets business objectives and intended outcome(s).
Proactively manage, escalate, and mitigate all issues and risks, engaging required parties, and escalating as needed, to drive to resolution and project deliverables remain on track.
Conduct root cause analysis in support of the business by recommending appropriate actions, strategies and/or alternatives to address business challenges.
Understand implications of proposed solutions or process changes and supply guidance on alternatives where necessary.
Track activity progress and build communication plan for implementation to ensure all impacted parties (up-stream/down-stream)are informed of next steps for completion and project status.
Effectively manage team/stakeholder expectations and engagement through clear and frequent communication regarding status updates, critical path progress, and variances from project plan.
Develop and participate in presentation and consultation with business partners on capabilities, performance results and can perform reasonability checks.