Manager, Process Excellence

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*CANDIDATES CAN LIVE ANYWHERE IN THE UNITED STATES*

Position Summary

The Process Excellence Manager will play a key role in supporting process improvement initiatives within the Operational Excellence Program, focusing on clinical operations, Utilization Management (UM), and Care Management (CM). This individual will support root cause analysis (RCA), Lean Six Sigma methodologies, and structured problem-solving techniques. They will support and/or facilitate cross-functional discussions to diagnose operational inefficiencies, drive process redesign efforts, and implement sustainable improvements. This role will work both independently as well as in support of Sr. Manager, Process Excellence. Traveling for this role requires the ability to travel at least 25% of the working time to support onsite working sessions with a project team. Additionally, they will collaborate with executive leadership, COE teams, and Quality & Audit to ensure seamless execution of process improvement recommendations.

Root Cause Analysis (RCA) & Process

• Support complex RCA investigations using relevant Lean Six Sigma tools and methodologies including, but not limited to, 5 Whys, Fishbone Diagrams, and Failure Mode Effect Analysis (FMEA) and other tools/methodologies
• Aid in identifying systemic process breakdowns impacting clinical decision-making and compliance
• Design and propose data-driven solutions for efficiency, quality, and compliance improvements

Cross-Functional Collaboration & Leadership

• Support and/or facilitate process improvement discussions with Utilization Management, Care Management, and Centers of Excellence teams
• Act as a liaison between Operational Excellence, Quality & Audit, Clinical Operations and regulatory teams
• Ensure all recommendations align with compliance, policy, and industry best practices
• Support training sessions on problem-solving frameworks and process improvement methodologies

Lean Six Sigma & Process Standardization

• Apply Lean Six Sigma methodologies to reduce inefficiencies & waste and improve quality in Clinical Operations
• Develop standard work procedures and best practices for sustainable process improvements
• Measure and analyze operational performance KPIs to track program effectiveness

Governance & Reporting

• Support bi-weekly executive leadership calls, providing RCA insights and updates
• Contribute to monthly Quality & Audit Review Board meetings with process findings
• Maintain documentation on RCA cases, issue resolutions, and process improvements

Required Qualifications

Experience:

• Minimum of 3 years of experience in process improvement, Lean Six Sigma, or operational excellence
• Experience in payer healthcare, Utilization Management (UM), Care Management (CM), or clinical operations strongly preferred.
• Proven expertise in RCA methodologies and process redesign within healthcare or regulated industries
• Expected ability to travel at least 25%

Technical & Process Skills:

• Lean Six Sigma Green Belt certification required (or lower certification with ability to obtain Green Belt within 12 months)
• Strong background in process mapping, data visualization, and statistical analysis (Excel, Power BI, Tableau preferred).
• Familiarity with regulatory compliance frameworks (CMS, NCQA, URAC) and payer operations

Leadership & Soft Skills:

• Ability to facilitate executive-level discussions and cross-functional problem-solving sessions
• Strong communication and presentation skills, with experience delivering findings to senior leadership
• Proven ability to drive change management and foster a culture of continuous improvement

Preferred Qualifications

• Minimum of 2 years serving as the lead on project management initiatives, with demonstrated responsibility for planning, execution, and delivery of cross-functional projects
• Experience supporting enterprise-wide process improvement initiatives in a payer or healthcare environment
• Experience working with clinical teams, care management, or utilization review functions
• Strong stakeholder engagement and ability to influence cross-functional teams without direct authority
• Proficiency in tools such as QuickBase, Power Apps, etc.
• Advanced skill level with Microsoft Office 365 suite

Education

• Bachelor's degree required, preferably in Business, Healthcare Administration, Industrial Engineering, Operations Management, or related field

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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