Senior Manager – Quality, Medicare Appeals
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Job Description
CVS Health Medicare Appeals quality leader driving data analytics, compliance, and audit readiness. Managing analysts and translating insights into measurable operational improvements.
Responsibilities:
- Lead cross-functional analysis of quality, audit, and operational data to identify trends and improvement opportunities
- Develop and present regular insights and performance reporting to leadership
- Drive action planning and follow-up with clear ownership, timelines, and measurable results
- Facilitate governance forums such as steering committees and workgroups
- Partner with Audit, Operations, Reporting, and Business Compliance to support compliance alignment and audit readiness
- Support implementation of process improvements, policy changes, and training initiatives
- Monitor quality and OMT performance indicators to identify risks and recommend corrective actions
- Promote consistency and standardization across quality processes and workflows
- Manage a team of senior analysts and Associate Managers
- Foster accountability, innovation, and continuous improvement
Requirements:
- 5+ years of experience in Medicare operations, quality, audit, or analytics
- Experience with data analysis, reporting, and performance management
- Ability to translate insights into operational improvements
- Strong problem-solving and cross-functional collaboration skills
- Effective communication and ability to present insights to leadership
- Experience in Medicare Appeals, Quality Assurance, or Audit environments preferred
- Familiarity with CMS regulations and compliance processes preferred
- Experience leading cross-functional initiatives or governance models preferred
- Strong analytical and reporting tool experience, such as dashboards and BI tools, preferred
- Bachelor's degree in Business, Healthcare Administration, or related field
- Master's degree preferred
Benefits:
- CVS Health bonus, commission or short-term incentive program
- Award target in the company’s equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
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