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CVS Health

Manager, Project Management – Prior Authorization

CVS Health

. Manage and coordinate projects and enhancements supporting Prior Authorization and Referral transactions, workflows, and provider experiences .

Posted 11/5/2026full-timeUnited StatesMid-LevelSenior💰 $60,300 - $132,600 per yearWebsite

Core Competencies

Role fit
Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in managing Prior Authorization and Referral workflows, including project management, requirements gathering, and production issue resolution. Strong analytical and communication skills are essential for translating technical issues into business language and facilitating cross-functional collaboration.

Highest-signal resume keywords
Prior Authorization WorkflowsProject ManagementProduction Issue ManagementRequirements GatheringHealthcare Experience

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Project ManagementRequirements GatheringBusiness TestingRoot-Cause IdentificationDefect ManagementImplementation SupportWorkflow AnalysisTransaction Behavior AnalysisMilestone TrackingRisk Management
Soft Skills
Analytical SkillsProblem-Solving SkillsCollaboration SkillsCommunication SkillsAdaptability
Industry Keywords
HealthcareEDIAuthorization WorkflowsReferral WorkflowsStakeholder CommunicationContinuous ImprovementProduction SupportFast-Paced EnvironmentOperational ResourceCross-Functional Coordination

About the role

Key responsibilities & impact
  • 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
  • Partner with business, technology, EDI, interoperability, and other stakeholders to investigate and resolve transaction and workflow-related issues
  • Coordinate 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 improvement opportunities
  • 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 support solution delivery with technology partners
  • Monitor deliverables, dependencies, risks, and outstanding decisions and proactively escalate delivery or provider-experience risks
  • Support intake and prioritization of enhancements, defects, and roadmap opportunities
  • Develop and maintain project, workflow, status-reporting, issue-tracking, and stakeholder-communication documentation
  • Facilitate cross-functional meetings and working sessions to drive decisions, remove blockers, and ensure ownership
  • Support implementation and post-release monitoring to validate outcomes and identify production issues
  • Act as an operational and project resource for continuous improvement of Prior Authorization and Referral capabilities and provider-facing workflows

Requirements

What you’ll need
  • 5–7 years of healthcare-related work experience
  • Experience supporting Authorization and Referral workflows, preferably within 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
  • Bachelor’s degree in Business Administration, Healthcare Administration, Information Systems, Project Management, or a related field preferred
  • Equivalent combination of education and relevant healthcare, Prior Authorization/Referral, EDI, or project management experience may be considered in lieu of a degree

Benefits

Comp & perks
  • CVS Health bonus, commission or short-term incentive program in addition to base pay
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being