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.

At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them.

As a Senior Manager, Provider Documentation Audit, you will play a critical role in supporting our Aetna members and our business by managing a production team that supports network growth initiatives through audit of provider application documentation. You will track and document quality and productivity metrics, providing actionable insights and performance data to support management decisions and training program development.

Responsibilities Include

• 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.

Required Qualifications

• 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

Preferred Qualifications

• 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
• We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. Aetna Service Operations office/hub locations will be discussed with the selected candidate

Education

• Bachelor’s degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$67,900.00 - $149,328.00

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 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

We anticipate the application window for this opening will close on: 04/11/2026

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