Senior Manager, Health Services - Aetna Medicaid Payment 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.At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them.As a key member of the Medical Policy & Program Solutions team, the Senior Manager, Health Services plays a critical role in supporting Aetna members and the business by leading clinical and claims-focused initiatives that drive program effectiveness, regulatory compliance, and cost management across Medicaid and Duals lines of business. This role manages a cross-functional team of payment policy writers professionals plus coordinates payment policies for Aetna Medicaid across 15 State Health Plans. This position will work closely with the Health Plan Governance to support each states specific requirements, documentation, compliance and regulations.The position is fully remote. Eligible candidates may reside anywhere in the contiguous United States.What you will do:Ensures compliance with healthcare regulations and policies for state Medicaid and Duals line of business as it related to payment policies.Facilitate cross-functional policy committees and manage implementation of committee decisions across all lines of businessManage MPPS Policy Project Management team of policy writersOversee all policy project work including monitoring & tracking of progress of status updates and communications.Manage resource utilization within and across policy teamPartner with vendor partners to implement policy solutions including creation of editing logic, drafting of test scenarios and publication of policy language.Support the operational processes of the Medicaid Health Policy GovernanceMonitor status reports to ensure effective workflow and timely development of coding and payment policiesSupport internal departments and processes in the development and implementation of policies and proceduresEnsure all medical policies are compliant with relevant regulations and are consistent across all lines of businessParticipate in department initiatives, scorable action items, and projectsWork with health plan business leaders and corporate leaders to develop deliverables on policy prioritiesProvide medical coding and payment policies deliverables for Medicaid and Duals and other markets as business needs changeWork with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed policiesCollaborate with interdisciplinary team members to achieve team goalsPerform any other job duties as requestedRequired Qualifications5+ years of payment policy experience in the health care industryCertified Professional Coder (AAPC or AHIMA), including Physician, Facility, or Payer certification1–2 years of project management experience3–5 years of claims and policy support experience in the healthcare industry; managed care experience preferredMinimum of 3 years of Medicaid and/or Duals experience, including code editing, policy development, and understanding of state guidelinesStrong verbal and written communication skillsExperience performing root cause analysis and identifying actionable solutionsExperience conducting claims analytics to validate industry standardsFamiliarity with claim editing software and the ability to propose system changesDemonstrated ability to meet project milestones and negotiate for resourcesHigh level of proficiency with the Microsoft Office suite, including advanced Excel skillsExperience with Lyric ClaimsXten and/or Cotiviti PPM and Coding Validation toolsPreferred QualificationsExperience with state Medicaid Regulation/GuidelinesEducationBachelor’s degree in healthcare administration, communications or related field - or equivalent experiencePay RangeThe typical pay range for this role is:$67,900.00 - $149,328.00This 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.  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 peopleWe 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: 06/23/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.