Project Manager - Utilization Management - Automation Team

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.

Position Summary
The Automation Team supports the implementation of strategic initiatives for the Utilization Management (UM) Clinical Services organization. These initiatives leverage advanced technologies such as artificial intelligence, rules engines, predictive analytics, intelligent character recognition, and cognitive AI to automate UM transactions, streamline workflows, and improve the experience for both providers and members. In addition, the team plays a key role in shaping and advancing the automation strategy by identifying high-impact opportunities, aligning initiatives with organizational goals, and driving continuous innovation and value realization.

This role is for a Project Manager within the Automation Team. The Project Manager will be responsible for supporting the delivery of multiple automation features from concept through implementation. They will also contribute to the strategic planning and prioritization of automation initiatives, ensuring alignment with business objectives and long-term transformation goals. The role works closely with business stakeholders to understand feature goals and partners with IT and architecture teams to define and deliver functional solutions. This includes documenting detailed business and technical requirements, user stories, and process flows to guide development efforts.

Key Accountabilities:

• Contribute to and support the product vision and roadmap for assigned automation features and initiatives.
• Translate business goals into user stories and acceptance criteria in collaboration with business and technical teams.
• Participate in backlog grooming, sprint planning, and prioritization to ensure timely delivery of high-quality features.
• Work with cross-functional teams including clinical, business, and IT partners to align on requirements and outcomes.
• Support tracking and communication of progress, risks, and issue resolution across features and projects.
• Identify opportunities to improve automation features, workflows, and user experience.
• Assist in defining success metrics and reporting on performance and value delivered.

Required Qualifications:

• 4–6 years of experience as a Project Manager, Product Owner, Sr. Business Analyst, or similar role delivering business or technical features in an Agile environment.
• Hands-on experience supporting the full project lifecycle: discovery, business case, requirements, development, testing, and release.
• Effective communication and collaboration skills across diverse stakeholder groups.
• Familiarity with working alongside technical teams such as architecture, development, and QA.
• Ability to manage multiple priorities in a dynamic, fast-paced environment.
• Experience developing or supporting business requirements documents and process flows.
• Experience in Managed Care or Healthcare

Preferred Qualifications:

• Experience in product development of microservices and APIs in a cloud-native architecture (e.g., AWS, Azure, GCP).
• Knowledge of FHIR, X12 EDI transactions, interoperability standards and other healthcare integration standards
• Strong understanding of Agile practices and experience using tools like Jira, Confluence, or similar platforms.
• Healthcare industry experience, especially in Utilization Management or clinical operations.
• Familiarity with clinical workflows, utilization review processes, and InterQual/MCG guidelines.
• Experience working in a SAFe or Scaled Agile environment
• Certified Scrum Product Owner (CSPO) or SAFe POPM (Product Owner/Product Manager) certified

Education:

• Bachelor’s degree in Business, Healthcare Administration, Computer Science, or a related field. Equivalent experience (6–8 years) in systems, technology, standards, and process improvement may be considered.

Sponsorship is not available for this position.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this positio