Process Manager

This is a fully remote position, open to applicants in Texas.

📋 Description

• Lead cross-functional projects focused on new ePA processes, workflow improvements, vendor onboarding, system integrations, automation capabilities, and operational enhancements.

• Collaborate with business leaders and stakeholders to assess ePA and interoperability processes, pinpointing areas for increased efficiency, scalability, and effectiveness.

• Develop and maintain relationships with external ePA vendors, network partners, and solution providers.

• Identify business risks, operational hurdles, and opportunities for ePA enhancements, and implement action plans accordingly.

• Schedule regular stakeholder meetings, operational reviews, and business updates.

• Discover avenues for innovation, automation, and process optimization.

• Evaluate business and customer needs, recommending new capabilities, process improvements, digital solutions, and emerging technologies.

• Track vendor performance, implementation progress, operational metrics, business outcomes, and value realization objectives.

• Assist in developing business cases, vendor assessments, contract reviews, and operational planning.

• Set success metrics, evaluate return on investment, and monitor value realization.

• Analyze operational performance, transaction trends, financial impacts, and process outcomes.

• Investigate emerging technologies, AI-driven capabilities, and workflow optimization prospects to enhance experiences for providers, clients, and members.

⛳️ Requirements

• 5-7 years of experience in healthcare operations, business process management, clinical operations, healthcare technology, healthcare interoperability, or a related area.

• Proficient in problem-solving and decision-making skills.

• Skilled in collaboration and teamwork.

• Strong growth mindset, demonstrating agility and a commitment to personal and professional development.

• Capable of effective execution and delivery, including planning, implementation, and support.

• Experience managing cross-functional initiatives that involve business, technology, operations, and external vendors.

• Excellent communication, stakeholder management, and relationship-building abilities.

• Familiarity with electronic Prior Authorization (ePA), Prior Authorization operations, Utilization Management, Pharmacy Benefit Management (PBM), or healthcare interoperability.

• Experience in managing relationships with healthcare technology vendors, ePA network partners, or interoperability solution providers.

• Knowledge of NCPDP SCRIPT standards, CMS interoperability requirements, FHIR APIs, and associated healthcare data exchange standards.

• Proven experience in leading vendor onboarding, enterprise implementations, integrations, and operational transformation initiatives.

• Project management experience in supporting complex cross-functional programs and strategic initiatives.

• Bachelor's degree preferred.

• 8-10 years of relevant experience in healthcare operations, clinical operations, vendor management, business process management, or related fields.

• Bachelor's degree preferred or an equivalent combination of specialized training, professional certification, and pertinent work experience.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Additional resources supporting physical, emotional, and financial well-being

• CVS Health bonus, commission, or short-term incentive program in addition to base pay