Sr. Manager , Digital Product - Fraud, Waste & Abuse (FWA) Program

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.