Sr. Manager , Digital Product - Fraud, Waste & Abuse (FWA) Program - CVS Health
Tallahassee, FL
About the Job
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
It’s a new day in healthcare!
Combining CVS Health and Aetna was a ground-breaking moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health.
In the past 4 years our membership has doubled and our market share has grown 50%; you will help us take all this to the next level, using your industry knowledge, passion for problem solving and quantitative analysis, and skills in communication and client management to identify, incubate, and deploy the next set of innovations to power the growth of tomorrow’s business!
As a Sr. Manager, Digital Product for Fraud, Waste & Abuse (FWA), you will oversee the maintenance and growth of the FWA program, delivering ~$75M in impact annually. Your work will directly impact the CVS Health Payment Optimization Analytics goals and contribute to achieving medical cost savings, revenue & ROI targets for analytics products. To achieve this, you will be responsible for monitoring, modifying and deploying expansion to our FWA identification analytics program.
Key Duties will be:
+ Understanding and knowing the roadmap and overall product strategy, serving as product and market specialist
+ Prioritizing which new features in the backlog will be added to the product
+ Understanding the customer needs and being able to interpret customer feedback
+ Developing and implementing project plans to achieve business goals
+ Proactively supporting project and/or business' by creating project documents, timelines that identifying key milestones and additional resources needed on selected project(s).
+ Serving as the voice & champion of POA by driving the growth of the analytics program in a methodical & orderly manner with proper business controls and reporting built into the program.
+ Identifying gaps and recommending enhancements related to new and/or existing products, services and workflows based on broad view of the organization.
+ Working directly with vendors and business partners to perform issue resolution.
+ Facilitating project teams and presenting updates to leadership, influencing various internal (cross-functional/segment) and external parties (e.g., vendor management).
+ Identifying issues that may stall project(s) and addresses them by either direct resolution, creating an alternative solution, or escalation to leadership.
+ Tracking progress and communicating project(s) status on a regular basis to all impacted parties.
+ Building communication plans for implementation to ensure all impacted parties (upstream/downstream) are informed of next steps for completion.
+ Overseeing vendor to ensure minimum service levels are maintained, quality work is performed, and financial targets are achieved.
Required Qualifications
+ 5+ years of product management/ownership experience including skills such as developing roadmaps, driving deliverables, partnering with key stakeholders, and a strong technical knowledge of products and systems.
+ 5+ years' experience working with healthcare analytics products and systems
+ 3+ years' experience meeting project milestones and negotiating for resources
+ 3+ years' experience developing best practice documentation
Preferred Qualifications
+ Knowledge of fraud, waste and abuse identification and management
+ Cross functional matrix partnership experience
+ Financial acumen
+ API experience
+ Agile, Lean and/or Six Sigma Project Management skills
+ Claims processing experience or End-to-End claims knowledge
+ Vendor management experience
+ Strong organizational skills
Education
+ Bachelor's degree required
+ MBA or Master’s degree preferred
Pay Range
The typical pay range for this role is:
$106,605.00 - $284,280.00
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 01/31/2025
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.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
It’s a new day in healthcare!
Combining CVS Health and Aetna was a ground-breaking moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health.
In the past 4 years our membership has doubled and our market share has grown 50%; you will help us take all this to the next level, using your industry knowledge, passion for problem solving and quantitative analysis, and skills in communication and client management to identify, incubate, and deploy the next set of innovations to power the growth of tomorrow’s business!
As a Sr. Manager, Digital Product for Fraud, Waste & Abuse (FWA), you will oversee the maintenance and growth of the FWA program, delivering ~$75M in impact annually. Your work will directly impact the CVS Health Payment Optimization Analytics goals and contribute to achieving medical cost savings, revenue & ROI targets for analytics products. To achieve this, you will be responsible for monitoring, modifying and deploying expansion to our FWA identification analytics program.
Key Duties will be:
+ Understanding and knowing the roadmap and overall product strategy, serving as product and market specialist
+ Prioritizing which new features in the backlog will be added to the product
+ Understanding the customer needs and being able to interpret customer feedback
+ Developing and implementing project plans to achieve business goals
+ Proactively supporting project and/or business' by creating project documents, timelines that identifying key milestones and additional resources needed on selected project(s).
+ Serving as the voice & champion of POA by driving the growth of the analytics program in a methodical & orderly manner with proper business controls and reporting built into the program.
+ Identifying gaps and recommending enhancements related to new and/or existing products, services and workflows based on broad view of the organization.
+ Working directly with vendors and business partners to perform issue resolution.
+ Facilitating project teams and presenting updates to leadership, influencing various internal (cross-functional/segment) and external parties (e.g., vendor management).
+ Identifying issues that may stall project(s) and addresses them by either direct resolution, creating an alternative solution, or escalation to leadership.
+ Tracking progress and communicating project(s) status on a regular basis to all impacted parties.
+ Building communication plans for implementation to ensure all impacted parties (upstream/downstream) are informed of next steps for completion.
+ Overseeing vendor to ensure minimum service levels are maintained, quality work is performed, and financial targets are achieved.
Required Qualifications
+ 5+ years of product management/ownership experience including skills such as developing roadmaps, driving deliverables, partnering with key stakeholders, and a strong technical knowledge of products and systems.
+ 5+ years' experience working with healthcare analytics products and systems
+ 3+ years' experience meeting project milestones and negotiating for resources
+ 3+ years' experience developing best practice documentation
Preferred Qualifications
+ Knowledge of fraud, waste and abuse identification and management
+ Cross functional matrix partnership experience
+ Financial acumen
+ API experience
+ Agile, Lean and/or Six Sigma Project Management skills
+ Claims processing experience or End-to-End claims knowledge
+ Vendor management experience
+ Strong organizational skills
Education
+ Bachelor's degree required
+ MBA or Master’s degree preferred
Pay Range
The typical pay range for this role is:
$106,605.00 - $284,280.00
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)
We anticipate the application window for this opening will close on: 01/31/2025
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.
Source : CVS Health