We'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.
Position Summary
Ideal candidate will work eastern or central time zone.
We are seeking an experienced and strategic Senior Project Manager to lead claim and clinical-focused initiatives. This role goes beyond traditional project management-it requires a strong business mindset, analytical capabilities, and the ability to design and implement solutions that improve business operations and outcomes. The ideal candidate will be deeply integrated into the business, acting as a Project Manager, Business Analyst, and Product Owner.
Key Responsibilities:
Lead and manage complex, cross-functional claims and medical management projects from initiation through execution and delivery.
Serve as a strategic partner to Operations leadership, deeply integrating into business operations to drive impactful outcomes. Act as both Project Manager and Business Analyst, analyzing business workflows, policies, and rules to design and implement effective solutions. Function as a Product Owner, translating business needs into actionable requirements and overseeing solution development.
Collaborate closely with IT teams to manage technical project components, ensuring alignment between business goals and system capabilities.
Develop and maintain detailed project documentation, including project plans, process flows, requirements, and status reports. Responsible for managing the budget and/or financial implications of more complex projects
Utilize data analytics and reporting tools to identify trends, solve problems, and drive continuous process improvement.
Communicate complex technical concepts in clear, business-friendly language to stakeholders, including internal and external partners.
Ensure projects are delivered on time, within scope, and aligned with strategic objectives.
Group facilitation/presentation influencing various internal (these may be cross-functional/segment) and external parties (e.g., vendor management)
Identifies issues that may stall project and addresses them by either resolving the issue or creating an alternative solution
Builds communication plans for implementation to ensure all impacted parties (upstream/downstream) are informed of next steps for completion
Acts as an advocate for change; may require influencing others to see the value in project, including managing interpersonal sensitivities and articulating the strategic view to ensure project alignment
Required Qualifications
5 years of proven experience leading health plan or medical management projects in a healthcare or managed care environment.
Strong analytical skills with proficiency in data analysis, reporting, and visualization tools (e.g., Excel, Power BI, Tableau).
Demonstrated ability to create and interpret process flows, business requirements, and technical documentation.
Experience in business analysis, including gathering and translating requirements, stakeholder engagement, and workflow optimization.
Familiarity with healthcare regulations, utilization management, claims processing, and healthcare operations.
Excellent organizational skills with a keen attention to detail and ability to manage multiple priorities.
Strong communication and interpersonal skills; able to build relationships across clinical, technical, and business teams.
Technical acumen to collaborate effectively with IT teams on system implementations, integrations, and enhancements.
Preferred Qualifications:
Proven track record in meeting project milestones and negotiating for resources.
Advanced user of PPT; Demonstrated ability to create executive summaries, presentation materials, other project artifacts.
Education
Bachelor's degree preferred in healthcare administration, business, or related field work experience, advanced degree or clinical background a plus
Pay Range
The typical pay range for this role is:
$75,400.00 - $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.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .
We anticipate the application window for this opening will close on: 04/26/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.
