Senior Manager - Quality - Medicare Appeals

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 Senior Manager - Quality - Medicare Appeals leads the development and execution of a data-driven quality strategy across Quality functions.

This role is responsible for identifying trends, developing insights, and ensuring that findings are translated into actionable improvements with measurable outcomes. The position partners closely with Audit, Operations, Reporting, and Business Compliance to support continuous improvement, regulatory alignment, and audit readiness.

Key Responsibilities

• Lead cross-functional analysis of quality, audit, and operational data to identify trends and improvement opportunities

• Develop and present regular insights and performance reporting to leadership

• Drive action planning and follow-up, ensuring clear ownership, timelines, and measurable results

• Facilitate governance forums (e.g., steering committees, workgroups) to prioritize initiatives and track progress

• Partner with Audit, Operations, Reporting, and Business Compliance to support compliance alignment and audit readiness

• Support implementation of process improvements, policy changes, and training initiatives

• Monitor performance indicators (including quality and OMT metrics) to identify risks and recommend corrective actions

• Promote consistency and standardization across quality processes and workflows

Team Leadership

• Manage a team of senior analysts, and Associate Managers

• Foster a culture of accountability, innovation, and continuous improvement

Required Qualifications

• 5+ years of experience in Medicare operations, quality, audit, or analytics

• Experience working with data analysis, reporting, and performance management

• Demonstrated ability to translate insights into operational improvements

• Strong problem-solving and cross-functional collaboration skills

• Effective communication and ability to present insights to leadership

Preferred Qualifications

• Experience in Medicare Appeals, Quality Assurance, or Audit environments

• Familiarity with CMS regulations and compliance processes

• Experience leading cross-functional initiatives or governance models

• Strong analytical and reporting tool experience (e.g., dashboards, BI tools)

Education

Bachelors degree in Business, Healthcare Administration, or related field (Masters preferred).

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00

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

Our 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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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. 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.

We anticipate the application window for this opening will close on: 08/14/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.