Manager, Business Analysis

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 ManagementPosition 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).

• 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.

• 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.

• 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.