Senior Manager, Regulatory Resolution Team

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 Regulatory Resolution Team is responsible for responding to highly sensitive and visible regulatory inquiries and complaints.  This team is responsible for delivering thorough reviews, advocacy, risk analysis, and collaborative resolutions that uphold regulatory compliance and drive member satisfaction. These inquiries require elite execution, precision, and compliance with state and federal regulations, internal operations and company policies. The RRT’s work is critical to protecting the organization’s reputation and maintaining trust with members, regulatory bodies and stakeholders.

Responsibilities include:

• Manage and lead of group of colleagues responsible for pulling together responses to member and provider regulatory complaints.

• Oversee the scheduling, drafting, timeliness and quality of regulatory responses.

• Proactively monitor team case load, status of response letters and associated due dates.

• Interface and negotiate with state and federal regulators, as needed.

• Build, maintain and promote positive and effective working relationships with internal and external stakeholders.

• Identify opportunities to streamline processes and improve efficiencies within the RRT and key business partners. Encourage staff to embrace new processes and identify change management opportunities within the team.

• Hold team accountable for meeting goals, due dates and expectations, identifying areas of individual performance concerns and coaching opportunities.

In order to be successful in this role you must exhibit the following:

• Strong skills in interpreting state and federal requirements.

• Ability to prioritize work in a fast-paced environment.

• Expert technical and written communication skills.

• Excellent problem solving and decision-making skills, including taking initiative to resolve complex issues and discern relevant information.  

Required Qualifications

• 7+ years of experience in health care industry or regulatory environment.

• 5+ years of experience in claim and payment policies and administration, operational, and clinical policies.

Preferred Qualifications

• Staff management experience.

• Adept at execution and delivery (planning, delivering, and supporting) skills.

• Adept at business intelligence.

• Adept at collaboration and teamwork.

• Mastery of problem solving and decision making skills.

• Mastery of growth mindset (agility and developing yourself and others) skills.

Education

Bachelors degree required or equivalent years of related experience.

Pay Range

The typical pay range for this role is:

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

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