CVS Health

Compensation

Full Description

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Job Title: Business Analyst – Utilization Management Position Summary: We are seeking a detail-oriented and analytical Business Analyst to support our Utilization Management initiatives. The ideal candidate will have a strong understanding of healthcare operations, data analysis, and business process improvement. This role will work closely with clinical, operational, and technical teams to ensure that utilization management processes are efficient, compliant, and aligned with organizational goals. Key Responsibilities: • Analyze and document business processes related to utilization management, identifying areas for improvement and automation. • Collaborate with stakeholders to gather and define business requirements for system enhancements and reporting needs. • Translate business needs into functional specifications for development and data teams. • Support the implementation of utilization management tools and workflows, ensuring alignment with clinical and regulatory standards. • Monitor and evaluate utilization trends, producing actionable insights and reports. • Assist in the development of dashboards and KPIs to track performance and compliance. • Facilitate meetings, workshops, and presentations to communicate findings and recommendations. • Ensure solutions meet business objectives and regulatory requirements (e.g., NCQA, CMS). Required Qualifications: • Bachelor’s degree in Business Administration, Healthcare Management, Information Systems, or related field. • 3 to 5 years of experience as a Business Analyst, preferably in a healthcare or managed care environment. • Strong understanding of utilization management processes and healthcare terminology. • Experience with data analysis tools (e.g., Excel, SQL, Tableau, Power BI). • Excellent communication, documentation, and stakeholder engagement skills. • Ability to work independently and manage multiple priorities in a fast-paced environment. Preferred Qualifications: • Familiarity with claims data, authorization workflows, and clinical guidelines. • Experience working with EHR systems or care management platforms. • Knowledge of regulatory standards such as HIPAA, NCQA, and CMS guidelines. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $72,360.00 - $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 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: 09/23/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.