Sr. Manager - Process Excellence

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

The Process Excellence Sr. Manager will play a key role in leading process improvement initiatives within the Operational Excellence Program, focusing on clinical operations, Utilization Management (UM), and Care Management (CM). This individual will serve as a subject matter expert in root cause analysis (RCA), Lean Six Sigma methodologies, and structured problem-solving techniques. They will facilitate cross-functional discussions to diagnose operational inefficiencies, drive process redesign efforts, and implement sustainable improvements. The role will be responsible for mentoring Green Belts and Yellow Belts, ensuring alignment with corporate quality, audit, and compliance standards. Additionally, they will collaborate with executive leadership, COE teams, and Quality & Audit to ensure seamless execution of process improvement recommendations.

Root Cause Analysis (RCA) & Process

• Lead complex RCA investigations using the 5 Whys, Fishbone Diagrams, and Failure Mode Effect Analysis (FMEA).
• Identify systemic process breakdowns impacting clinical decision-making and compliance.
• Design and propose data-driven solutions for efficiency, quality, and compliance improvements.

Cross-Functional Collaboration & Leadership

• Facilitate process improvement discussions with UM, CM, and COE teams.
• Act as a liaison between Operational Excellence, Quality & Audit, and regulatory teams.
• Ensure all recommendations align with compliance, policy, and industry best practices

Lean Six Sigma & Process Standardization

• Apply Lean Six Sigma methodologies to reduce inefficiencies and waste in clinical operations.
• Develop standard work procedures and best practices for sustainable process improvements.
• Measure and analyze operational performance KPIs to track program effectiveness.

Coaching & Mentorship

• Mentor and develop Green Belt and Yellow Belt team members, ensuring alignment with RCA best practices.
• Provide training sessions on problem-solving frameworks and process improvement methodologies.

Governance & Reporting

• Support bi-weekly executive leadership calls, providing RCA insights and updates.
• Contribute to monthly Quality & Audit Review Board meetings with process findings.
• Maintain documentation on RCA cases, issue resolutions, and process improvements.

Required Qualifications

Experience:

• Minimum of 7 to 10+ years of experience in process improvement, Lean Six Sigma, or operational excellence.
• Experience in payer healthcare, Utilization Management (UM), Care Management (CM), or clinical operations strongly preferred.
• Proven expertise in RCA methodologies and process redesign within healthcare or regulated industries.

Technical & Process Skills:

• Lean Six Sigma Green Belt or Black Belt certification required (or ability to obtain within 12 months).
• Strong background in process mapping, data visualization, and statistical analysis (Excel, Power BI, Tableau preferred).
• Familiarity with regulatory compliance frameworks (CMS, NCQA, URAC) and payer operations.

Leadership & Soft Skills:

• Ability to facilitate executive-level discussions and cross-functional problem-solving sessions.
• Strong communication and presentation skills, with experience delivering findings to senior leadership.
• Proven ability to drive change management and foster a culture of continuous improvement.

Preferred Qualifications

• Master’s degree in Healthcare Administration, Business, or related field.
• Lean Six Sigma Black Belt certification preferred.
• Experience leading enterprise-wide process improvement initiatives in a payer or healthcare environment.
• Experience working with clinical teams, care management, or utilization review functions.
• Strong stakeholder engagement and ability to influence cross-functional teams without direct authority.

Education

• Bachelor’s degree required, preferably in Business, Healthcare Administration, Industrial Engineering, Operation