Project Manager, Prior Authorization and Referral Transactions

CVS Health · Work from home, PA · $60,300.00 - $132,600.00 · remote We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience. As a Project Manager, Prior Authorization and Referral Transactions, you will be responsible for the project management, operational coordination, and production support of Prior Authorization and Referral transactions and provider-facing workflows. Responsibilities Manage and coordinate projects and enhancements supporting Prior Authorization and Referral transactions, workflows, and provider experiences. Serve as a primary point of contact for Production Support ticket issues, coordinating investigation, escalation, tracking, and resolution with appropriate business and technology partners. Partner with business, technology, EDI, interoperability, and other stakeholders to investigate and resolve transaction and workflow-related issues. Coordinate project activities including requirements gathering, documentation, milestone tracking, risk and issue management, testing, implementation readiness, and post-production support. Support analysis of Prior Authorization and Referral transaction behavior and provider workflows to identify root causes, recurring issues, and opportunities for improvement. Coordinate business testing activities for system enhancements and releases, including test scenario development, defect management, validation, and implementation support. Translate business and provider needs into clear requirements and work with technology partners to support solution delivery. Monitor project deliverables, dependencies, risks, and outstanding decisions and proactively escalate items that could affect delivery or the provider experience. Support intake and prioritization of enhancements, defects, and roadmap opportunities impacting Prior Authorization and Referral capabilities. Develop and maintain project documentation, workflow documentation, status reporting, issue tracking, and stakeholder communications. Facilitate cross-functional meetings and working sessions to drive decisions, remove blockers, and ensure clear ownership of deliverables. Support implementation and post-release monitoring to validate expected outcomes and quickly identify production issues. Act as a key operational and project resource for continuous improvement of Prior Authorization and Referral transaction capabilities and provider-facing workflows. Requirements 5–7 years of healthcare-related work experience. Experience supporting Authorization and Referral workflows, preferably within payer, provider, EDI, or healthcare transaction environments. Demonstrated project management experience coordinating work across business and technology teams. Experience with production issue management, including investigation, triage, escalation, root-cause identification, and coordination through resolution. Experience supporting requirements gathering, business testing, implementation, and post-production activities. Strong analytical, problem-solving, and decision-making skills. Strong collaboration and teamwork skills with the ability to coordinate across multiple business and technology stakeholders. Strong written and verbal communication skills, including the ability to translate technical or transaction-related issues into clear business language. Ability to manage multiple priorities, project deliverables, and production issues in a fast-paced environment. Demonstrated growth mindset, adaptability, and willingness to develop deeper expertise in Prior Authorization and Referral capabilities. Education Bachelor’s degree in Business Administration, Healthcare Administration, Information Systems, Project Management, or a related field preferred. Equivalent combination of education and relevant healthcare, Prior Authorization/Referral, EDI, or project management experience may be considered in lieu of a degree. Benefits Medical, dental, and vision co