Senior Manager, Audit and Business Oversight

Position Summary Planned, monitors, and manages internal projects from initiation through completion. Secures required resources and uses formal processes and tools to manage resources, budgets, risks, and changes. Manages projects to ensure on‑time completion according to specifications and within budgeted costs. What you will do Act as a top‑level specialist on project management and develop a comprehensive plan that encompasses objectives, deliverables, and timelines for CMS and/or State regulatory audits and readiness reviews. Ensure alignment on key deliverables and timelines and reinforce organizational standards. Apply highly developed knowledge of external audit standards and expectations to guide operational partners through all aspects of an audit, including data production, audit practice sessions, facilitation of audit sessions, delivery of post‑audit deliverables, working with operations to mitigate audit risk, and oversight of root cause and corrective action planning. Analyze business documentation to ensure accurate and complete responses to auditor/regulator. Ensure operational processes are aligned with regulatory and organizational requirements. Oversee operational key performance indicators to measure progress and analyze root cause and corrective action plans when goals are not achieved. Create a continuous improvement environment, looking for ways to enhance delivery processes and outcomes. Effectively manage multiple audits and projects and respond to change with adaptability. Use indirect management skills to ensure projects remain on track and escalates as appropriate. Ensure implementation of new or revised regulatory requirements. Required Qualifications 7–10 years of work experience in healthcare. Experience in Medicare claims and claims processing requirements. Medicare and/or Medicare Integrated Duals/SNP Product Experience. In depth knowledge of CMS and/or State SMAC regulatory requirements, including experience supporting audits, validations, or regulatory reviews. Minimum of 3 years of experience leading projects or initiatives, including planning, execution, and delivery of results. Minimum of 3 years of experience in roles requiring high levels of accuracy and attention to detail. Strong problem‑solving and decision‑making skills, with the ability to analyze complex issues and recommend effective solutions. Experience dealing with state and/or federal regulators, including preparation of documentation, responses, and issue resolution. Demonstrated ability to manage multiple priorities and deadlines while maintaining accuracy, completeness, and attention to detail. Excellent organizational and written communication skills with a focus on clarity, precision, and professionalism. Demonstrated ability to work with all levels of the organization. Preferred Qualifications Adept at collaboration and teamwork. Adept at growth mindset (agility and developing yourself and others). Adept at execution and delivery (planning, delivering, and supporting). Adept at business intelligence. Bachelor's degree preferred but relevant job experience will be accepted. Pay Range The typical pay range for this role is $82,940.00 – $182,549.00. This 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 and includes an award target in the company’s equity award program. Benefits 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. Benefits 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. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. #J-18808-Ljbffr 4062 Aetna Resources, LLC