Senior Cvs Health Utilization Management Jobs in Raleigh, NC

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.

This position is an individual contributor role

Position Summary

Designs enterprise-wide and/or cross-functional solutions to address business problems, supporting Medicaid value based operational strategies. This work results in initiatives that significantly impact organizational strategy, enabling the organization to be competitive in the marketplace and effectively serve its customers. Partners with business owners to optimize the achievement of strategic business objectives, to include profitable growth and improved organizational effectiveness.

• Assists in managing the day-to-day complex business consultation services to support the organization's goals and objectives.

• Implements processes and assignments for research, collecting, analyzing, and compiling data and information for the business consulting department reports.

• Assesses files, reports, and financial records, and manages department record retention.

• Directs individuals to develop a high degree of customer service by fielding internal and external inquiries, finding resolutions, or redirecting as appropriate.

• Confers internally and externally with clients and senior management regarding the organization's goals and objectives.

• Coaches the internal and external department point of contact ensuring concise communication with employees, stakeholders, and members of the senior management.

• Delivers advice to the organization regarding current business trends and best practices by preparing analyses for senior management, stakeholders, and clients.

• Implements processes to performance appraisals within the business consulting department ensuring compliance and continuous improvement.

• Helps establish and implement strategic review processes ensuring continuous improvement, compliance, and high-performance standards are upheld.

Required Qualifications

• 3-5 years experience, including Medicaid focused work

• Adept at problem solving and decision making skills

• Adept at collaboration and teamwork

• Adept at growth mindset (agility and developing yourself and others) skills

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

Preferred Qualifications

• Experience with Medicaid value-based programs is a plus.

• Background in operationalization of value based programs and resources.

Education

• Bachelor's degree or equivalent professional work experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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.

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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 09/05/2026

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.