Lead Director – UM Center of Excellence
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Posted: 10/21/2026Lead Director – UM Center of Excellence
CVS HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in Utilization Management operations, policy governance, and compliance within healthcare settings, with a strong focus on stakeholder engagement and continuous improvement. Proven ability to lead multidisciplinary teams and establish effective governance models that enhance operational performance and ensure regulatory adherence.
Highest-signal resume keywords
Utilization Management OperationsPolicy GovernanceHealthcare Regulatory ComplianceStakeholder EngagementTeam Leadership
About the role
Key responsibilities & impact- Set the strategy, operating model, standards, and priorities for UM policy and process governance across supported lines of business
- Lead development, review, approval, publication, maintenance, and annual review of UM policies, procedures, amendments, desktops, job aids, templates, letters, and fax forms
- Ensure guidance defines UM responsibilities and supports regulatory submission, licensure, accreditation, audit, and contractual requirements
- Chair and mature governance forums, establishing roles, decision rights, approval pathways, escalation practices, and accountability
- Own governance for the CS Hub and related content repositories, including quality, searchability, formatting, version control, and lifecycle management
- Oversee intake and impact assessment for requests affecting UM documents and workflows
- Evaluate current-state and future-state requirements, determine downstream impacts, and secure stakeholder review and sign-off
- Partner with UM Operations, Medical Affairs, Legal, Compliance, NCQA, Quality and Audit, Training, Communications, Technology/DDAT, and other enterprise teams
- Consult on system enhancements and operational changes affecting UM workflows and documentation
- Establish and monitor governance performance measures, including intake volume, turnaround time, backlog, defects, compliance incidents, review completion, adoption, usability, and release activity
- Use data and stakeholder feedback to identify gaps, standardize guidance, improve usability, reduce defects, and connect policy with frontline execution
- Coordinate approved changes with operational readiness, training, communications, and audit partners
- Lead post-publication monitoring and continuous improvement
- Lead, coach, and develop a multidisciplinary Policy & Process Governance team
- Foster accountability, collaboration, disciplined governance, customer focus, and continuous improvement
Requirements
What you’ll need- 10-15 years of progressive experience in healthcare operations, Utilization Management, clinical operations, policy administration, process governance, compliance, or a related function, preferably within a health plan or managed care organization
- Demonstrated leadership of enterprise policy, procedure, workflow, job aid, or business content governance in a complex, regulated environment
- Deep understanding of Utilization Management operations and the relationship among policies, procedures, workflows, documentation, letters, systems, and frontline execution
- Working knowledge of healthcare regulatory and accreditation expectations, including CMS, NCQA, federal and state requirements, and Medicaid contractual considerations
- Experience establishing governance models, facilitating cross-functional decision-making, managing intake and prioritization, and driving accountability for content quality and lifecycle management
- Strong analytical capabilities with experience using operational metrics, dashboards, audit findings, and stakeholder feedback to improve performance and mitigate risk
- Exceptional executive communication, stakeholder engagement, influence, negotiation, and issue-resolution skills
- Proven ability to lead and develop teams, manage competing priorities, and maintain high standards in a dynamic enterprise environment
- Strong judgment, attention to detail, and commitment to clear, consistent, accessible, and compliant UM guidance
- Bachelor's degree or equivalent relevant professional experience required
- Advanced degree or specialized training in healthcare administration, clinical operations, business, public health, or a related field preferred
Benefits
Comp & perks- 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Policy DevelopmentProcess GovernanceOperational Metrics AnalysisQuality AssuranceLifecycle Management
Soft Skills
Executive CommunicationNegotiationIssue ResolutionAttention to DetailCollaboration
Industry Keywords
Healthcare OperationsClinical OperationsNCQACMSManaged Care Organization