Lead Director - UM Center of Excellence

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.

• →10-15 years of progressive experience in healthcare operations, Utilization Management, clinical operations, policy administration, process governance, compliance, or a related function, preferably within a health plan or managed care organization.
• → Demonstrated leadership of enterprise policy, procedure, workflow, job aid, or business content governance in a complex, regulated environment.
• →Deep understanding of Utilization Management operations and the relationship among policies, procedures, workflows, documentation, letters, systems, and frontline execution.·       Working knowledge of healthcare regulatory and accreditation expectations, including CMS, NCQA, federal and state requirements, and Medicaid contractual considerations.
• →Experience establishing governance models, facilitating cross-functional decision-making, managing intake and prioritization, and driving accountability for content quality and lifecycle management.
• →Strong analytical capabilities with experience using operational metrics, dashboards, audit findings, and stakeholder feedback to improve performance and mitigate risk.
• →Exceptional executive communication, stakeholder engagement, influence, negotiation, and issue-resolution skills.
• →Proven ability to lead and develop teams, manage competing priorities, and maintain high standards in a dynamic enterprise environment.
• →Strong judgment, attention to detail, and commitment to clear, consistent, accessible, and compliant UM guidance.

The typical pay range for this role is: