Senior Manager, Provider Documentation Audit

CVS Health

Senior Manager overseeing provider documentation audit for Aetna Health. Manage production team supporting network growth and ensure compliance with documentation standards.

Posted 5/1/2026full-timeMontana • 🇺🇸 United StatesSenior💰 $67,900 - $149,328 per yearWebsite

About the role

Key responsibilities & impact

Oversee and manage the end-to-end delivery of accurate and complete required documentation for network growth initiatives, including document intake, audit review and approval process and tracking and documentation
Drive collaboration cross-functionally to support network growth initiatives
Offer expert guidance on provider application requirements, conducts audits to ensure data integrity, and initiates or supports remediation efforts as needed to maintain high standards of operational excellence
Project management oversight, process improvement and documentation development and maintenance
Develop and maintain key performance indicators for team production, designs and regularly presents timely and transparent performance reporting to leadership with proactive identification of risks and appropriate mitigation plans
Identify and mitigate risks, escalating issues promptly and proposing effective solutions to overcome project challenges
Coordinate with cross-functional implementation team, collaborates effectively with network partners and health plan SMEs to meet implementation initiative needs
Work closely with leadership & business stakeholders to secure new implementation planning approval, funding/resource alignment and initiate execution plans
Manage pipeline of new implementation initiatives and overseeing the evaluation of multiple requests at any given time
Manage multiple concurrent reporting initiatives with critical deadlines, while working within established processes and identifying improvement opportunities
Ensure intake, audit and tracking standards are followed
Cultivate and manage relationships with various internal business partners
Exercise sound judgment and critical thinking skills, demonstrates analytical/problem-solving skills
Assess organizational needs to optimally build a functional team through formal training, diverse assignments, communication, coaching, mentoring and performance management accountable for hiring and developing staff members
Manage operational aspects of the team (e.g., budget, performance, and compliance), and implements workforce and succession plans to meet business needs

Requirements

What you’ll need

7+ years of experience in health insurance industry, preferably in a role related to network, provider, or payer operations
Experience collaborating with business partners to successfully implement large organization initiatives
Experience applying data and analytical insights to drive informed business outcomes, tell a story and provide leadership level insights
Experience leading teams in a high production, deadline driven environment
2-3 years Project management experience
Demonstrated experience leveraging tools including QuickBase, Excel (pivot tables, basic formulas), and SharePoint to support data analysis and workflow collaboration
Excellent verbal and written communication skills, with experience creating clear, impactful presentations in PowerPoint
Medicaid experience

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support physical, emotional, and financial well-being

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

project managementdata analysisperformance reportingrisk mitigationprocess improvementdocumentation developmentauditingprovider application requirementsteam production managementcompliance management

Soft Skills

collaborationcommunicationcritical thinkinganalytical skillsproblem-solvingrelationship managementleadershipcoachingmentoringjudgment