Health Services Manager (IC), Evaluation & Management Policy Management – Aetna MPPS

Location: PA - Work from home

Remote Type: Remote

Time Type: Full time

Job Description

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 Health Services Manager is a key member of the Medical Policy & Program Solutions (MPPS) team supporting the Evaluation & Management (E&M) Program. This individual contributor role is responsible for managing and influencing health care quality projects and initiatives that support E&M Program objectives. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business units to meet business needs and accomplish strategic goals.

This is a fully remote position. Eligible candidates will live anywhere in the contiguous United States.

Key Responsibilities

• Leads the work and deliverables of multiple, complex programs, and supports business initiatives, that impact multiple processes, systems, functions, and products.
• Identify and validate the appropriate medical, coding, reimbursement, and pre-payment policies applicable to each request.
• Ensure deviation recommendations align with policy intent, clinical guidelines, contractual obligations, and regulatory requirements.
• Conduct quality reviews to validate policy alignment, decision accuracy, documentation integrity, and governance compliance.
• Perform periodic audits and implementation reviews to verify approved deviations are operationalized accurately.
• Develop reporting and performance metrics related to deviation volumes, turnaround times, approval outcomes, and quality performance.
• Analyze deviation trends, appeals, quality findings, and recurring exception requests to identify opportunities for policy clarification and process improvement.
• Lead initiatives focused on improving review consistency and strengthening controls.
• Collaborates and partners with other functional managers, other business areas/across the segments.
• Develop and implement innovative ideas that support work/teams.
• Assist others to identify solutions to issues that negatively impact program and/or project plan.
• Convert technical findings and complex data visualization into clear, actionable business strategies.

Required Qualifications

• 5+ years of medical, payment or clinical policy experience
• Certified Professional Coder (ie: CPC, CCS, RHIT)
• Experience with business analytics with focus on data analysis for decision-making
• Proficient in Microsoft Excel, Word, Power Point, Tableau and Power BI
• Ability to work independently, think creatively, and proactively identify process improvement and automation opportunities
• Exceptional written and verbal communication skills
• Demonstrated organizational and prioritization abilities
• Effective problem-solving and sound decision-making skills

Preferred Qualifications

• Certified Evaluation and Management Coder (CEMC)
• Familiarity or experience with Evaluation and Management
• Familiar with AMA CPT/HCPCS codes, ICD-10 Codes, Medicare Policies and NCD/LCD’s
• Code editing and quality review experience related to payment policies, projects, and programs
• QuickBase applications
• Project management 

Education

Bachelor’s degree or equivalent* experience

*Equivalent years of experience defined by CVS Policy: If candidate has associate’s degree, additional 2 years of experience is needed; if candidate has no degree, additional 4 years of experience is needed.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

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. 
 

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: 09/12/2026

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