{"id":2113720,"url":"https://alion.io/job/cvs-health-senior-manager-mpps-experience-optimization","title":"Senior Manager MPPS Experience Optimization","company":{"id":4223,"name":"CVS Health","domain":"cvshealth.com","url":"https://alion.io/company/cvshealth","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":null},"role":"Communications","role_family":"Communications","seniority":"senior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":67900,"max":182549,"currency":"USD","period":"year","gross":null,"usd_annual":182549},"salary_estimate":null,"experience_years_min":5,"visa_sponsorship":false,"relocation_package":false,"has_equity":true,"technologies":[],"status":"live","first_seen_at":"2026-10-08T23:09:25Z","employer_posted_date":"2026-10-08","last_verified_at":"2026-10-18T13:49:42Z","board_verified":true,"closed_at":null,"days_open":9,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":9},"description":"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.\nThe Senior Manager MPPS Experience Optimization leads data-driven strategies to improve medical and payment policy effectiveness and the provider experience. This role leverages claims, appeals, coding, reimbursement, provider experience, and operational insights to identify optimization opportunities, translate findings into actionable recommendations, and lead cross-functional initiatives that reduce unnecessary administrative burden and drive measurable improvement.\nPolicy and Experience Optimization\nDevelop and execute strategies to identify, evaluate, prioritize, and advance medical and payment policy optimization opportunities.\nLeverage claims, appeals, coding, reimbursement, provider, and operational data to identify trends, friction points, and opportunities for improvement.\nEvaluate and modernize policies to improve clarity, consistency, effectiveness, and applicability across the claims lifecycle, including both pre-payment and post-payment use.\nDevelop evidence-based recommendations that balance policy intent, clinical and coding standards, provider experience, compliance, and business impact.\nEstablish consistent approaches and performance measures to advance optimization opportunities from analysis through implementation and measurement.\nExperience Optimization Program Leadership\nProvide strategic leadership for experience optimization programs and maintain a prioritized portfolio of opportunities aligned with enterprise objectives.\nDevelop proactive, data-driven approaches to identify emerging and systemic opportunities for policy and process improvement.\nEstablish effective intake, prioritization, governance, and decision-making practices for optimization initiatives.\nPartner with analytics and technology teams to develop reporting and insights that strengthen visibility into policy performance and outcomes.\nEstablish success measures, evaluate results, and translate recurring trends into broader improvement strategies.\nCross-Functional and Strategic Leadership\nPartner across medical policy, clinical, coding, payment integrity, claims, appeals, provider, compliance, operations, analytics, technology, and other key functions.\nLead cross-functional evaluation of complex policy opportunities and translate findings into clear recommendations, risks, tradeoffs, and expected outcomes.\nInfluence senior leaders and stakeholders across a matrixed organization to advance policy optimization decisions and initiatives.\nEstablish effective partnerships and handoffs across policy development, remediation, configuration, implementation, and operational teams.\nPromote data-driven decision-making and continuous improvement while providing leadership, coaching, and development to team members.\nRequired Qualifications\n5+ years of experience in healthcare, medical or payment policy, payment integrity, coding, claims, appeals, healthcare analytics, provider experience, or related healthcare functions.\nSupervisory or formal people-leadership experience required.\nDemonstrated experience using multiple data sources to identify trends, performance gaps, and optimization opportunities and translate findings into actionable recommendations.\nStrong knowledge of healthcare reimbursement, claims processing, medical and/or payment policy, and coding concepts, including CPT, HCPCS, and ICD-10.\nExperience leading complex, cross-functional initiatives from analysis and recommendation through implementation and measurement.\nDemonstrated ability to communicate complex findings, influence decision-making, and collaborate effectively across a matrixed organization.\nStrong strategic thinking, analytical problem-solving, communication, and stakeholder-management skills.\nPreferred Qualifications\nExperience in policy optimization, payment integrity, provider experience, appeals, reimbursement strategy, or medical policy.\nExperience analyzing claims, denials, appeals, overturns, utilization, reimbursement, or provider-related data.\nExperience with payment policy, E&M coding, claim-editing concepts, or complex reimbursement methodologies.\nExperience developing performance measures, dashboards, or monitoring frameworks to evaluate policy or program effectiveness.\nEducation\nBachelor’s degree in healthcare administration, business, public health, health informatics, nursing, analytics, or a related field, or equivalent professional experience.\nRelevant healthcare or coding credential, such as CPC, CCS, RHIT, or an equivalent credential, required or must be obtained within one year of employment.\nLocation\nCandidate may reside anywhere in the United States.\nPay Range\nThe typical pay range for this role is:\n$67,900.00 - $182,549.00This 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. \nOur 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.\nGreat benefits for great people\nWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.\nThis 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.\nWe anticipate the application window for this opening will close on: 10/14/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.","description_format":"text","description_chars":6716,"description_truncated":false,"requirements":{"experience_years_min":5,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"bachelor","optional":false},"security_clearance":false,"languages":[]},"benefits":["Equity","Wellness"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Health Care","Primary Care & Medical Centers","Pharmacies","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-10-08T23:09:25Z"}],"visa":[],"liveness":{"score":24,"band":"cold","label":"Long shot","p_open":1,"p_active":0.685,"p_room":0.35,"age_days":8,"expected_fill_days":4,"reasons":["conf:1","velocity","win:tail","comp:brand"],"computed_at":"2026-10-17T05:46:00Z"},"pay":{"stated_usd_annual":182549,"is_top_pay":true},"html_url":"https://alion.io/job/cvs-health-senior-manager-mpps-experience-optimization","json_url":"https://alion.io/job/cvs-health-senior-manager-mpps-experience-optimization.json","meta":{"generated_at":"2026-10-18T20:04:30Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":24161,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-19T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":4223},"rest":"https://alion.io/mcp/rest/get_company?id=4223"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fcvs-health-senior-manager-mpps-experience-optimization"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fcvs-health-senior-manager-mpps-experience-optimization"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fcvs-health-senior-manager-mpps-experience-optimization"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/cvs-health-senior-manager-mpps-experience-optimization\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fcvs-health-senior-manager-mpps-experience-optimization"}]}