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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

This leader is responsible for leading and directing a diverse team to promote outcomes related to service performance, customer satisfaction, financial performance, and quality. The Sr. Manager will collaborate with upstream and downstream functional areas to support clients as well as enterprise products. This role will provide leadership and oversight of the Prior Authorization Administration team and the Clinical Non-Adjudication team and their critical role in ensuring the appropriate applications are configured to support key operational functions.

This leader will be responsible for leading and supporting the implementation, compliance, delivery, and execution of the PA programs across our book of business for Medicare, Commercial (Health Plan, Employer, Coalition) and Marketplace Exchange clients that have delegated PA services to the PBM. The Sr. Manager may have 4-6 direct work from home (WFH) employees. The role will be responsible for driving departmental productivity, quality, development, and engagement. The Sr. Manager must have critical thinking skills and superior problem solving capabilities to root cause and pursue possible enterprise solutions. Other duties will be required to meet business needs. They will operate with a high level of flexibility to meet the demands of a production environment, regulatory/accreditation landscape, and client customization.

The Sr. Manager is accountable for all financial, regulatory, and operational outcomes, colleague and team development, and expected to collaborate with all peers and colleagues at all levels to ensure adoption with all new and existing client implementations, testing of Prior Authorization & Appeals Process/System(s), as well as readiness for regulatory, accreditation and client audits and required reporting. This leader will be accountable for achieving the operational targets for compliance, execution, member/beneficiary & provider service experience, client retention, client customization, revenue growth and lowest cost to service expense strategy.

Required Qualifications:

2+ years of experience with PA Administration configuration and testing processes. (CAS, MedHok, Novologix)

6-8 years leadership experience

Education

Bachelor's degree and/or equivalent work experience

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/31/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.