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.
At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them.
As a key member of the Medical Policy & Program Solutions team, the Senior Manager, Health Services plays a critical role in supporting Aetna members and the business by leading clinical and claims-focused initiatives that drive program effectiveness, regulatory compliance, and cost management across Medicaid and Duals lines of business. This role manages a cross-functional team of payment policy writers professionals plus coordinates payment policies for Aetna Medicaid across 15 State Health Plans. This position will work closely with the Health Plan Governance to support each states specific requirements, documentation, compliance and regulations.
The position is fully remote. Eligible candidates may reside anywhere in the contiguous United States.
What you will do:
- Ensures compliance with healthcare regulations and policies for state Medicaid and Duals line of business as it related to payment policies.
- Facilitate cross-functional policy committees and manage implementation of committee decisions across all lines of business
- Manage MPPS Policy Project Management team of policy writers
- Oversee all policy project work including monitoring & tracking of progress of status updates and communications.
- Manage resource utilization within and across policy team
- Partner with vendor partners to implement policy solutions including creation of editing logic, drafting of test scenarios and publication of policy language.
- Support the operational processes of the Medicaid Health Policy Governance
- Monitor status reports to ensure effective workflow and timely development of coding and payment policies
- Support internal departments and processes in the development and implementation of policies and procedures
- Ensure all medical policies are compliant with relevant regulations and are consistent across all lines of business
- Participate in department initiatives, scorable action items, and projects
- Work with health plan business leaders and corporate leaders to develop deliverables on policy priorities
- Provide medical coding and payment policies deliverables for Medicaid and Duals and other markets as business needs change
- Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policies
- Collaborate with interdisciplinary team members to achieve team goals
- Perform any other job duties as requested
Required Qualifications
- 5+ years of payment policy experience in the health care industry
- Certified Professional Coder (AAPC or AHIMA), including Physician, Facility, or Payer certification
- 1–2 years of project management experience
- 3–5 years of claims and policy support experience in the healthcare industry; managed care experience preferred
- Minimum of 3 years of Medicaid and/or Duals experience, including code editing, policy development, and understanding of state guidelines
- Strong verbal and written communication skills
- Experience performing root cause analysis and identifying actionable solutions
- Experience conducting claims analytics to validate industry standards
- Familiarity with claim editing software and the ability to propose system changes
- Demonstrated ability to meet project milestones and negotiate for resources
- High level of proficiency with the Microsoft Office suite, including advanced Excel skills
- Experience with Lyric ClaimsXten and/or Cotiviti PPM and Coding Validation tools
Preferred Qualifications
- Experience with state Medicaid Regulation/Guidelines
Education
Bachelor’s degree in healthcare administration, communications or related field - or equivalent experience
Pay Range
The typical pay range for this role is:
$67,900.00 - $149,328.00
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 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: 06/23/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
