Project Manager Medical Policy

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.

The Medical Policy Project Manager provides project leadership, governance support, and operational coordination for medical policy and pre-payment policy initiatives. This role ensures strategic, regulatory, and scorecard-driven initiatives are planned, executed, documented, and implemented across business, clinical, compliance, technology, analytics, and operations partners. The position supports compliant, accurate, and operationally ready medical policy solutions that improve payment accuracy and business performance.

• Project execution: Manage medical policy, pre-payment policy, regulatory, payment integrity, and scorecard-driven initiatives from intake through implementation and closeout. Develop project plans, milestones, timelines, risks, dependencies, and deliverables to ensure work is completed on time, within scope, and aligned to business objectives.
• Stakeholder engagement and governance: Partner with medical policy, clinical, compliance, legal, operations, technology, analytics, and business stakeholders to define objectives, requirements, decisions, and implementation needs. Support governance routines that promote alignment, accountability, and timely decision-making.
• Reporting and issue management: Prepare project status reports, executive updates, dashboards, and leadership summaries that highlight progress, risks, issues, dependencies, mitigation plans, and required decisions. Maintain action logs with clear owners, due dates, and follow-up status.
• Meeting facilitation and communications: Facilitate project meetings, working sessions, and governance discussions. Prepare agendas and materials, document decisions, track follow-up actions, and draft communications aligned to Medical Policy and Pre-Payment Policy priorities.
• Process improvement: Conduct post-implementation reviews, capture lessons learned, identify barriers or defects, and recommend improvements that strengthen project management practices, implementation readiness, auditability, and operational effectiveness.
• Special projects: Support time-sensitive or ad hoc assignments by coordinating planning, documentation, stakeholder engagement, escalation, and completion within agreed timelines.

• 5+ years of experience in healthcare, health plan operations, clinical operations, medical policy, pre-payment policy, payment integrity, claims, regulatory implementation, or related operational functions.
• Strong project management skills, including project planning, milestone tracking, risk and issue management, dependency management, action tracking, governance documentation, and implementation readiness.
• Working knowledge of medical terminology, healthcare policy, claims payment concepts, pre-payment policy processes, and regulatory or compliance requirements; familiarity with CMS and other regulatory bodies preferred.
• Ability to lead through influence in a matrixed environment and collaborate with clinical, compliance, legal, operations, technology, analytics, and business stakeholders.
• Excellent written and verbal communication skills, including the ability to translate complex policy, regulatory, and operational topics into clear leadership-ready materials.
• Strong organization, prioritization, and time-management skills, with the ability to manage competing priorities, confidential information, and time-sensitive deliverables with attention to detail.
• Proficiency with Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook, Teams, and SharePoint; experience with Smartsheet, Asana, or similar project tracking and reporting tools preferred.
• Commitment to continuous improvement, accountability, operational excellence, inclusion, and a collaborative team culture.

• Experience in medical policy, pre-payment policy, payment integrity, claims editing, regulatory implementation, or health plan operations.
• Experience developing project plans, implementation materials, leadership updates, risk summaries, decision logs, and governance documentation.
• Experience facilitating cross-functional meetings, documenting decisions, tracking action items, and supporting timely follow-through.
• Knowledge of process improvement practices, including root cause analysis, defect prevention, workflow redesign, or Lean/Six Sigma methods.
• Proficiency with Microsoft Office, SharePoint, Teams, Smartsheet, Jira, Power BI, Visio, or similar project tracking and reporting tools.
• Strong attention to detail, business judgment, communication skills, and ability to handle confidential…