Senior Project Manager, Business Operations

CVS Health is dedicated to building a more connected and compassionate health experience. They are seeking a strategic Senior Project Manager to lead claim and clinical-focused initiatives, requiring a strong business mindset and analytical capabilities to improve business operations and outcomes.

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

Requirements:

• 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
• 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