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 UM Innovation Technical Delivery Team supports strategic initiatives for the Utilization Management (UM) Clinical Services organization. The team leverages advanced technologies such as artificial intelligence (AI), rules engines, predictive analytics, intelligent document processing, and automation solutions to streamline UM processes, improve operational efficiency, and enhance the experience of both providers and members. In addition, the team helps shape the organization's automation strategy by identifying high-value opportunities, aligning solutions with business goals, and driving continuous innovation.
The selected candidate will lead the delivery of technology solutions from concept through implementation. Working closely with business stakeholders, architects, engineers, and program leadership, this individual will translate business needs into scalable solutions that deliver measurable value. Responsibilities include defining and refining requirements and user stories, managing and prioritizing the product backlog, participating in Agile ceremonies, supporting planning activities, facilitating solution demonstrations, and ensuring successful delivery of key initiatives.
The ideal candidate combines strong business and technical expertise and is comfortable collaborating with architects and engineers on solution design and implementation decisions. While not a hands-on developer, the candidate should be able to effectively discuss APIs, system integrations, rules engines, microservices, healthcare EDI transactions, and enterprise architecture concepts. Success in this role requires a proven track record of leading complex, cross-functional technology initiatives and delivering innovative solutions that drive meaningful business outcomes.
Key Accountabilities
- Lead the design, planning, pilot, and delivery of automation and technology solutions from concept through implementation, ensuring alignment with business objectives and strategic priorities.
- Partner with business stakeholders, product owners, architects, and engineering teams to translate business needs into scalable technical solutions, user stories, acceptance criteria, and delivery plans.
- Manage and prioritize the product backlog, facilitate PI planning, sprint planning, backlog refinement, and other Agile ceremonies to ensure successful and timely delivery of features.
- Drive cross-functional collaboration across business, operations, clinical, and technology teams to align requirements, manage dependencies, and achieve desired business outcomes.
- Develop and maintain project artifacts including business requirements, process flows, outcome measurements, dashboards, roadmaps, and governance documentation.
- Monitor initiative progress, identify and mitigate risks, resolve issues, and provide regular status updates and executive-level reporting to program and organizational leadership.
- Evaluate and challenge solution designs, architecture decisions, and implementation approaches while effectively communicating with engineers, architects, and technical stakeholders regarding APIs, integrations, rules engines, microservices, EDI, and enterprise technology platforms.
Required Qualifications
- 8+ years of experience leading complex technology delivery, enterprise programs, product initiatives, or large-scale UM Innovation using AI/GenAI technologies.
- Healthcare payer industry experience required, including expertise in Utilization Management (UM), Prior Authorization, Clinical Operations, Claims, Care Management, or related domains.
- Demonstrated success partnering with Architecture, Engineering, Product, Operations, and vendor organizations to deliver strategic business outcomes.
- Strong knowledge of Software Development Life Cycle (SDLC), Agile and SAFe methodologies, release management, quality assurance, testing, and deployment practices.
- Proven ability to influence stakeholders, drive alignment across cross-functional teams, and communicate effectively with both technical and executive audiences.
Technical Delivery & Solution Leadership
- Experience leading the delivery of enterprise solutions across hybrid environments, including Multi-cloud, SaaS, vendor-hosted, and legacy platforms.
- Strong understanding of modern application architecture, including .NET and Java based ecosystems, microservices, APIs, and distributed systems.
- Ability to translate business objectives into scalable technical solutions and effectively challenge design assumptions and technical decisions when appropriate.
- Experience managing technical dependencies, integration strategies, solution roadmaps, and cross-functional delivery teams.
- Demonstrated ability to lead solution design sessions, architecture reviews, technical governance processes, and implementation planning activities.
- Ability to interpret and evaluate architecture diagrams, data flows, sequence diagrams, integration patterns, and the ability to support technical teams with API management.
Architecture & Integration Expertise
- Working knowledge of RESTful APIs, JSON, OpenAPI/Swagger specifications, and API lifecycle management.
- Experience using API testing and validation tools such as Postman.
- Understanding of API Gateway technologies, microservices patterns, event-driven architecture, and messaging frameworks.
- Knowledge of enterprise integration design and best practices for connecting complex business and technology ecosystems.
- Familiarity with healthcare interoperability and integration standards, including FHIR, HL7, and Documentation Requirements Lookup Service (DTR).
- Understanding of healthcare EDI transactions, including 278, 837, 835, and 270/271 transaction sets.
Decision Automation & Rules Management
- Experience implementing, supporting, or optimizing business rules and decision automation platforms used for workflow automation, eligibility determination, prior authorization, utilization management, policy administration, or claims processing.
- Strong understanding of decision management concepts, including Decision Tables, Decision Trees, Business Rule Authoring and Automated Decision Services
- Experience with IBM Operational Decision Manager (ODM) or comparable rules engine and decision automation platforms.
- Ability to design and support configurable business rules that enable rapid policy and workflow changes with minimal or no code modifications.
Preferred Qualifications
- Experience leading automation, workflow modernization, AI-enabled, or digital transformation initiatives within healthcare organizations.
- SAFe Product Owner/Product Manager (POPM), SAFe Agilist, Agile, PMP, or related certifications.
- Experience working with enterprise automation, case management, workflow orchestration, or decision management platforms.
- Strong analytical, problem-solving, and continuous improvement mindset with a focus on delivering measurable business value.
Education:
- Bachelor’s degree in business, Information Technology, Computer Science, Healthcare Administration, or a related field; equivalent experience (6-8 years) will be considered.
Pay Range
The typical pay range for this role is:
$75,400.00 - $182,549.00
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. 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 8+ years of experience leading complex technology delivery, enterprise programs, product initiatives, or large-scale UM Innovation using AI/GenAI technologies
- Healthcare payer industry experience, including Utilization Management, Prior Authorization, Clinical Operations, Claims, Care Management, or related domains
- Experience partnering with Architecture, Engineering, Product, Operations, and vendor organizations to deliver strategic business outcomes
- Strong knowledge of SDLC, Agile and SAFe methodologies, release management, quality assurance, testing, and deployment practices
- Ability to influence stakeholders, drive cross-functional alignment, and communicate with technical and executive audiences
- Experience leading enterprise solutions across multi-cloud, SaaS, vendor-hosted, and legacy environments
- Understanding of modern application architecture, including .NET, Java, microservices, APIs, and distributed systems
- Experience managing technical dependencies, integration strategies, solution roadmaps, and cross-functional delivery teams
- Experience leading solution design sessions, architecture reviews, technical governance, and implementation planning
- Working knowledge of RESTful APIs, JSON, OpenAPI/Swagger, and API lifecycle management
- Experience with API testing and validation tools such as Postman
- Knowledge of API gateways, microservices, event-driven architecture, messaging frameworks, and enterprise integration
- Familiarity with healthcare interoperability standards including FHIR, HL7, and DTR
- Understanding of healthcare EDI transactions including 278, 837, 835, and 270/271
- Experience implementing, supporting, or optimizing business rules and decision automation platforms
- Understanding of decision tables, decision trees, business rule authoring, and automated decision services
- Experience with IBM Operational Decision Manager or comparable rules-engine platforms
- Bachelor's degree in business, Information Technology, Computer Science, Healthcare Administration, or a related field; equivalent experience may be considered
- Experience leading healthcare automation, workflow modernization, AI-enabled, or digital transformation initiatives
- SAFe POPM, SAFe Agilist, Agile, PMP, or related certification
- Experience with enterprise automation, case management, workflow orchestration, or decision management platforms
- Strong analytical, problem-solving, and continuous improvement skills
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision plans, plus no-cost preventive care and virtual primary and mental-health services. Wellness offerings extend to MinuteClinic programs, gym discounts, and multiple no-cost counseling sessions.
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Wellbeing & Lifestyle Benefits — Wellbeing resources such as confidential counseling, 24/7 support, fitness programs, and employee discounts are presented as part of a broad package. Education assistance, tuition reimbursement, and options to earn certain degrees with no out-of-pocket tuition further enhance total rewards.
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Retirement Support — Retirement programs include a 401(k) savings plan with possible employer matching and an employee stock purchase plan. Financial coaching and related tools are highlighted to support long-term financial security.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
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