Senior Manager MPPS Policy Enablement
4062 Aetna Resources, LLCWe’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.
Primary Job Duties & Responsibilities
Develops and implements strategies to improve healthcare delivery, patient outcomes, and organizational performance.
Directs health service activities and operations by managing staff, budgets, and resources to ensure efficient workflow and employee adherence to quality and safety standards.
Delivers leadership and guidance to healthcare teams, including physicians, nurses, administrative staff, and other professionals.
Establishes quality control methods and quality improvement initiatives to enhance the overall quality of healthcare services.
Advocates for the needs and rights of patients within the organization by addressing patient concerns, resolving complaints, and implementing strategies to improve patient satisfaction and overall experience.
Collaborates with other departments, healthcare providers, and external stakeholders to foster meaningful partnerships and ensure seamless coordination of healthcare services.
Analyzes data related to health services, such as patient outcomes, utilization rates, and financial performance, and leverages this information to generate reports, identify areas for improvement, and make data-driven decisions.
Ensures compliance with healthcare regulations and policies, such as privacy laws, accreditation requirements, and safety standards.
Leads and mentors a team of healthcare professionals, providing guidance, and promoting professional development.
Candidate may reside anywhere in the US
Required:
5+ years medical coding and policy oversight at a managed care payer, specifically administering NCD/LCD policies
3 years leadership experience
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) (aligns with medical policy + coding roles) required and/or obtained within one year of start date in role
Education
Bachelor's degree preferred/specialized training/relevant professional qualification.
Preferred:
Payment accuracy configuration experience with Lyric
Essential Qualifications
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at business intelligence
Adept at collaboration and teamwork
Mastery of problem solving and decision making skills
Mastery of growth mindset (agility and developing yourself and others) skills
Pay Range
The typical pay range for this role is:
$67,900.00 - $182,549.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.