Position SummaryThe Manager, Process is responsible for evaluating, implementing, and optimizing business processes that support electronic Prior Authorization (ePA). This role partners with Clinical Operations, Technology, Medical Affairs, Compliance, and external vendors to drive operational excellence, support digital transformation efforts, and improve provider and member experiences.
The Manager, Process serves as a key liaison between internal stakeholders and external partners, providing consulting, implementation, and operational support to maximize business value, improve efficiency, and support enterprise strategic objectives.
What you will do- Lead cross functional initiatives involving the implementation of new ePA processes, workflow enhancements, vendor onboarding, system integrations, automation capabilities, and operational improvements.
- Meet with business leaders and stakeholders to understand objectives, evaluate current ePA and interoperability processes, and identify opportunities to improve operational efficiency, scalability, and effectiveness. Build and manage relationships with ePA external vendors, network partners, and solution providers to ensure successful delivery of business objectives, operational commitments, service level expectations, and strategic outcomes.
- Identify business risks, operational challenges, and ePA improvement opportunities, and work with internal and external partners to develop and execute action plans that drive measurable results.
- Develop a cadence of regular, proactive meetings to establish strong relationships with key stakeholders, deliver operational reviews and business updates, and identify opportunities for innovation, automation, and process optimization.
- Assess business and customer needs and communicate recommendations for new capabilities, process enhancements, digital solutions, and emerging technologies that support organizational goals.
- Monitor vendor performance, implementation progress, operational metrics, business outcomes, and value realization objectives, proactively identifying and addressing risks and opportunities.
- Support business case development, vendor evaluations, contract reviews, and operational planning activities while partnering with leadership to establish success metrics, measure return on investment, and track value realization against expected business outcomes.
- Analyze operational performance, transaction trends, financial and operational impacts, and process outcomes to identify opportunities for automation, efficiency gains, cost savings, and continuous improvement. Promote a culture of innovation and continuous improvement by evaluating emerging technologies, AI enabled capabilities, and workflow optimization opportunities that enhance provider, client, and member experiences.
Required Qualifications- 5-7 years of experience in healthcare operations, business process management, clinical operations, healthcare technology, healthcare interoperability, or a related field.
- Adept at problem solving and decision making skills.
- Adept at collaboration and teamwork.
- Adept at growth mindset (agility and developing yourself and others) skills.
- Adept at execution and delivery (planning, delivering, and supporting) skills.
- Experience leading cross functional initiatives involving business, technology, operations, and external vendors.
- Strong communication, stakeholder management, and relationship building skills.
Preferred Qualifications- Experience with electronic Prior Authorization (ePA), Prior Authorization operations, Utilization Management, Pharmacy Benefit Management (PBM), or healthcare interoperability.
- Experience managing relationships with healthcare technology vendors, ePA network partners, or interoperability solution providers.
- Knowledge of NCPDP SCRIPT standards, CMS interoperability requirements, FHIR APIs, and related healthcare data exchange standards.
- Experience leading vendor onboarding, enterprise implementations, integrations, and operational transformation initiatives.
- Project management experience supporting complex cross-functional programs and strategic initiatives.
- Bachelor's degree preferred.
- 8-10 years of relevant experience in healthcare operations, clinical operations, vendor management, business process management, or related disciplines.
Education- Bachelor's degree preferred or equivalent combination of specialized training, professional certification, and relevant work experience.
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$60,300.00 - $132,600.00
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.
Great benefits for great peopleWe 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.
We anticipate the application window for this opening will close on: 10/31/2026
