Description

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.

Senior Manager, Operational Efficiency - Medicaid Operations

As our Medicaid footprint expands, operational complexity has grown significantly. Key functions-enrollment, provider data management, member services, claims operations management. This senior leader will identify process gaps, design improvements, and drive implementation, where there is a member/provider dissatisfaction specially around provider data accuracy and provider directory, they will work with departments to understand root cause issues and implement gap closures and correcting root cause.

Key Responsibilities

• Lead initiatives to improve provider and member data accuracy including improvement in provider directory.

• Lead and direct several orphaned processes and workflows.

• Conduct root cause analysis of operational issues and design cross-functional solutions.

• Serve as a liaison between business operations and technology teams to align automation and system improvements.

• Support operational readiness for regulatory changes.

• Reduce inefficiencies in several processes.

• Plans, implements, and manages operations programs and strategies

• Supports, develops, and validates compliance with operations policies, procedures, and regulations Reviews, manages, and drives operations efficiency, quality, and financial performance

• Supports business direction and develops, implements, and oversees operational models to meet the business requirements of Aetna Better Health.

• Verifies improvements and operations are evaluated based on appropriate quantitative and qualitative measures

• Verifies optimized operations, including training and educating staff from different departments on COMAR and ABHMD contract.

• Develops collaborative relationships with and confirms business partners can execute day-to-day responsibility for operations (e.g., member services center, enrollment, technology)

• Informs and advises the COO regarding state's current trends, problems, and activities to facilitate both short- and long-range strategic plans to improve operational performance and enhance growth

• Owns end-to-end process improvement: definition of need, project plans, status updates, reporting and achieving results

• Identifies and resolves technical, operational, and organizational problems inside and outside Aetna Better Health

• Validates all operational activities conform to contract compliance for all programs

• Understands and manages the state requirements and relationship related to operations

• Directs others to resolve business problems that affect multiple functions or disciplines

• Evaluates outcomes based on qualitative and quantitative measures and adjusts accordingly

Required Qualifications

• 5+ years of experience as an operational leader

• 3+ years of professional experience in Medicaid

• Experience related to publicly funded government health care programs (e.g., Medicaid, Medicare, or state health care programs for the uninsured)

• Operations experience in Medicaid, Medicare, or government health care program administration

• Solid problem solving skills and business planning skills within a matrix environment

• Demonstrated experience advising IT resources related to enterprise platform initiatives and provide direction on platform migration

• Bachelor's degree or equivalent work experience preferred

Pay Range

The typical pay range for this role is:

$82,940.00 - $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 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: 03/08/2026

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