Senior Manager – Medical Policy, Program Solutions

CVS Health

. Develop and execute strategies to identify, evaluate, prioritize, and advance medical and payment policy optimization opportunities .

Posted 10/8/2026full-timeRemote • United StatesSenior💰 $67,900 - $182,549 per yearWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in healthcare policy optimization, leveraging data analytics to drive strategic recommendations and improve operational performance. Proven ability to lead cross-functional initiatives and influence stakeholders while ensuring compliance with coding and reimbursement standards.

Highest-signal resume keywords

Healthcare Policy OptimizationClaims ProcessingHealthcare AnalyticsLeadership ExperienceStrategic Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisPolicy DevelopmentCPT CodingHCPCS CodingICD-10 CodingPerformance MeasurementOperational ImprovementCross-Functional LeadershipRecommendation ImplementationTrend Identification

Soft Skills

CommunicationStakeholder ManagementAnalytical Problem-SolvingInfluencing SkillsCollaboration

Certifications & Qualifications

CPCCCSRHIT

Industry Keywords

HealthcarePayment IntegrityClaimsAppealsProvider ExperienceReimbursementClinical StandardsComplianceOperational TeamsMatrixed Organization

About the role

Key responsibilities & impact

Develop and execute strategies to identify, evaluate, prioritize, and advance medical and payment policy optimization opportunities
Leverage claims, appeals, coding, reimbursement, provider, and operational data to identify trends, friction points, and improvement opportunities
Evaluate and modernize policies across the claims lifecycle, including pre-payment and post-payment use
Develop evidence-based recommendations balancing policy intent, clinical and coding standards, provider experience, compliance, and business impact
Establish approaches and performance measures to advance opportunities from analysis through implementation and measurement
Provide strategic leadership for experience optimization programs and maintain a prioritized portfolio aligned with enterprise objectives
Establish intake, prioritization, governance, and decision-making practices
Partner with analytics and technology teams to develop reporting and insights
Evaluate results and translate recurring trends into broader improvement strategies
Lead cross-functional evaluations and translate findings into recommendations, risks, tradeoffs, and expected outcomes
Influence senior leaders and stakeholders across a matrixed organization
Establish partnerships and handoffs across policy development, remediation, configuration, implementation, and operational teams
Provide leadership, coaching, and development to team members

Requirements

What you’ll need

5+ years of experience in healthcare, medical or payment policy, payment integrity, coding, claims, appeals, healthcare analytics, provider experience, or related healthcare functions
Supervisory or formal people-leadership experience required
Experience using multiple data sources to identify trends, performance gaps, and optimization opportunities and translate findings into actionable recommendations
Strong knowledge of healthcare reimbursement, claims processing, medical and/or payment policy, and coding concepts, including CPT, HCPCS, and ICD-10
Experience leading complex, cross-functional initiatives from analysis and recommendation through implementation and measurement
Ability to communicate complex findings, influence decision-making, and collaborate across a matrixed organization
Strong strategic thinking, analytical problem-solving, communication, and stakeholder-management skills
Bachelor’s degree in healthcare administration, business, public health, health informatics, nursing, analytics, or a related field, or equivalent professional experience
Relevant healthcare or coding credential, such as CPC, CCS, RHIT, or an equivalent credential, required or must be obtained within one year of employment

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
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