Position SummaryThe UM Innovation Technical Delivery Team supports strategic initiatives for the Utilization Management (UM) Clinical Services organization. The team leverages advanced technologies such as artificial intelligence (AI), rules engines, predictive analytics, intelligent document processing, and automation solutions to streamline UM processes, improve operational efficiency, and enhance the experience of both providers and members. In addition, the team helps shape the organization's automation strategy by identifying high-value opportunities, aligning solutions with business goals, and driving continuous innovation.
The selected candidate will lead the delivery of technology solutions from concept through implementation. Working closely with business stakeholders, architects, engineers, and program leadership, this individual will translate business needs into scalable solutions that deliver measurable value. Responsibilities include defining and refining requirements and user stories, managing and prioritizing the product backlog, participating in Agile ceremonies, supporting planning activities, facilitating solution demonstrations, and ensuring successful delivery of key initiatives.
The ideal candidate combines strong business and technical expertise and is comfortable collaborating with architects and engineers on solution design and implementation decisions. While not a hands-on developer, the candidate should be able to effectively discuss APIs, system integrations, rules engines, microservices, healthcare EDI transactions, and enterprise architecture concepts. Success in this role requires a proven track record of leading complex, cross-functional technology initiatives and delivering innovative solutions that drive meaningful business outcomes.
Key Accountabilities- Lead the design, planning, pilot, and delivery of automation and technology solutions from concept through implementation, ensuring alignment with business objectives and strategic priorities.
- Partner with business stakeholders, product owners, architects, and engineering teams to translate business needs into scalable technical solutions, user stories, acceptance criteria, and delivery plans.
- Manage and prioritize the product backlog, facilitate PI planning, sprint planning, backlog refinement, and other Agile ceremonies to ensure successful and timely delivery of features.
- Drive cross-functional collaboration across business, operations, clinical, and technology teams to align requirements, manage dependencies, and achieve desired business outcomes.
- Develop and maintain project artifacts including business requirements, process flows, outcome measurements, dashboards, roadmaps, and governance documentation.
- Monitor initiative progress, identify and mitigate risks, resolve issues, and provide regular status updates and executive-level reporting to program and organizational leadership.
- Evaluate and challenge solution designs, architecture decisions, and implementation approaches while effectively communicating with engineers, architects, and technical stakeholders regarding APIs, integrations, rules engines, microservices, EDI, and enterprise technology platforms.
Required Qualifications- 8+ years of experience leading complex technology delivery, enterprise programs, product initiatives, or large-scale UM Innovation using AI/GenAI technologies.
- Healthcare payer industry experience required, including expertise in Utilization Management (UM), Prior Authorization, Clinical Operations, Claims, Care Management, or related domains.
- Demonstrated success partnering with Architecture, Engineering, Product, Operations, and vendor organizations to deliver strategic business outcomes.
- Strong knowledge of Software Development Life Cycle (SDLC), Agile and SAFe methodologies, release management, quality assurance, testing, and deployment practices.
- Proven ability to influence stakeholders, drive alignment across cross-functional teams, and communicate effectively with both technical and executive audiences.
Technical Delivery & Solution Leadership- Experience leading the delivery of enterprise solutions across hybrid environments, including Multi-cloud, SaaS, vendor-hosted, and legacy platforms.
- Strong understanding of modern application architecture, including .NET and Java based ecosystems, microservices, APIs, and distributed systems.
- Ability to translate business objectives into scalable technical solutions and effectively challenge design assumptions and technical decisions when appropriate.
- Experience managing technical dependencies, integration strategies, solution roadmaps, and cross-functional delivery teams.
- Demonstrated ability to lead solution design sessions, architecture reviews, technical governance processes, and implementation planning activities.
- Ability to interpret and evaluate architecture diagrams, data flows, sequence diagrams, integration patterns, and the ability to support technical teams with API management.
Architecture & Integration Expertise- Working knowledge of RESTful APIs, JSON, OpenAPI/Swagger specifications, and API lifecycle management.
- Experience using API testing and validation tools such as Postman.
- Understanding of API Gateway technologies, microservices patterns, event-driven architecture, and messaging frameworks.
- Knowledge of enterprise integration design and best practices for connecting complex business and technology ecosystems.
- Familiarity with healthcare interoperability and integration standards, including FHIR, HL7, and Documentation Requirements Lookup Service (DTR).
- Understanding of healthcare EDI transactions, including 278, 837, 835, and 270/271 transaction sets.
Decision Automation & Rules Management- Experience implementing, supporting, or optimizing business rules and decision automation platforms used for workflow automation, eligibility determination, prior authorization, utilization management, policy administration, or claims processing.
- Strong understanding of decision management concepts, including Decision Tables, Decision Trees, Business Rule Authoring and Automated Decision Services
- Experience with IBM Operational Decision Manager (ODM) or comparable rules engine and decision automation platforms.
- Ability to design and support configurable business rules that enable rapid policy and workflow changes with minimal or no code modifications.
Preferred Qualifications- Experience leading automation, workflow modernization, AI-enabled, or digital transformation initiatives within healthcare organizations.
- SAFe Product Owner/Product Manager (POPM), SAFe Agilist, Agile, PMP, or related certifications.
- Experience working with enterprise automation, case management, workflow orchestration, or decision management platforms.
- Strong analytical, problem-solving, and continuous improvement mindset with a focus on delivering measurable business value.
Education:- Bachelor's degree in business, Information Technology, Computer Science, Healthcare Administration, or a related field; equivalent experience (6-8 years) will be considered.
Pay RangeThe 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.
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: 10/02/2026
