Manager, Medical Economics Job at CVS Health (Work at Home)

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.

Job Responsibility

Perform audits of provider-related data, and financial arrangements to validate compliance with contract terms, internal policies, and regulatory requirements
Review and assess documentation, calculations, data sources, and system outputs related to Medical Economics processes
Independently identify audit exceptions, root causes, and risk levels, ensuring findings are supported by clear evidence
Apply defined audit criteria, scoring methodologies, and sampling approaches consistently across audits
Serve as a primary audit point of contact within MEU for provider groups, delegated vendors, and network partners when audit activity requires external coordination
Communicate audit scope, findings, and remediation expectations clearly and professionally to external providers and internal network teams
Participate in audit discussions that may involve sensitive financial or operational impacts, maintaining professionalism and objectivity
Document audit results, findings, and remediation actions in audit tools, trackers, and workpapers with a high level of accuracy and clarity
Track findings through remediation and verification, escalating risks and delays as needed
Contribute to audit summaries, trend reporting, and leadership-ready materials that support ongoing network quality improvement

Requirements

5+ years working experience
Bachelor's degree or equivalent experience in healthcare administration, finance, business, economics, or a related field
Experience performing audits, quality reviews, or compliance assessments within healthcare, payer operations, provider networks, or vendor management
Ability to analyze data, documentation, and calculations to identify discrepancies and assess financial or compliance impact
Demonstrated ability engaging with external partners or providers through clear written and verbal communications
Demonstrated ability to manage multiple audits or workstreams while meeting deadlines

Nice to have

Experience supporting Medical Economics, provider contracting, provider data, charge master, or network operations
Familiarity with provider audit processes, data integrity reviews, or quality programs
Experience documenting audit results in structured tools (e.g., Excel-based audit tools, trackers, or reporting systems)
Comfort working cross-functionally with Network Management, Hospitals and Ancillary facilities
Advanced Excel skills (audit tracking, documentation, and reporting)

What we offer

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs

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Manager, Medical Economics

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