field_remote_option

job_industry

field_job_occupational_field_parents_all

job_organization_name

job_upgrade_is_featured

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.Position Summary:Legal Counsel provides legal guidance, interpretation, advice, and recommendations for action to internal stakeholders and senior/executive management regarding federal/state regulations in the healthcare industry. Counsel serves as a subject matter expert by providing legal advice and interpretation of new legal requirements.Responsibilities &amp; Duties:<ul> <li>Provides legal advice and counsel to promote the company's mandates and protect the overall interests of the company.</li> <li>Prepares communication with state regulators, examiners, and/or consultants within expected deadlines/short timelines. </li> <li>Legal research and analysis related to state laws and regulations and market conduct findings reports. </li> <li>Supports legal review, analysis, and outcomes of state mental health parity exams.</li> <li>Legal review and assessment of any adverse state findings and consent orders.</li> <li>Identifies and reviews legal risk for business areas/subject matter experts for purposes of assessing market conduct impact and corrective action plans. </li> <li>Provides legal expertise on company-wide initiatives, which may require legal research and advice related to various parts of the CVS Health enterprise.</li> <li>Works collaboratively and cross functionally with a variety of areas including other members of the legal department, Compliance, Government Affairs, Regulatory Affairs, and business operations teams to implement new laws and regulations for assigned areas.</li> <li>Assists with onboarding junior-level staff to promote the development of departmental capabilities.</li> </ul>In order to be successful in this role you must exhibit the following:<ul> <li>Mastery of problem solving and decision-making skills.</li> <li>Mastery of collaboration and teamwork.</li> <li>Mastery of growth mindset (agility and developing yourself and others) skills. </li> <li>Mastery of execution and delivery (planning, delivering, and supporting) skills. </li> <li>Mastery of business intelligence. </li> </ul>Required Qualifications5+ years of experience as a practicing attorney.2+ years of healthcare law experience.Admitted to practice in at least one state and in good standing.Ability to travel up to 5%. Preferred QualificationsIn-house Counsel Certification (ICC) preferred. In depth knowledge of healthcare laws, regulations and industry standards governing the provision of healthcare.Experience working with state and federal government agencies.Healthcare laws and regulations including for example, ACA, Medicare, Medicaid, AWP/parity, pharmacy and/or mental health parity. Experience working with PBMs and/or the pharmacy division of a health plan and/or with health plans. EducationJD required Pay RangeThe typical pay range for this role is:$144,200.00 - $288,400.00 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. This position also includes an award target in the company’s equity award program. 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Legal Counsel

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.Manager, Assumptions GovernancePosition Summary:As Manager, Assumptions Governance, you will be responsible for key support functions for CVS Health’s PBM assumptions management. This role is critical in ensuring PBM forecasting accuracy by supporting the underwriting and finance forecasting process as well as assisting with other financial processes. Primary responsibilities include understanding, assessing, and implementing financial and utilization assumptions and artifacts; leveraging a combination of data driven insights and market dynamics to validate and vet assumptions; leverage market leading tools for the CFAO &amp; PBM Finance organizations to review and maintain assumptions and artifacts; and communicating to business partners.Additionally, this position will:<ul> <li>Manage assumptions across the PBM organization including finance, supply chain and other key areas. Partner with Business resources to gather, refine and evaluate assumptions and artifacts to impact the Underwriting process.</li> <li>Foster strong links to the PBM finance team regarding forecasting assumptions, client profitability efforts, and financial governance of underwriting activities.</li> <li>Support discussions that are highly complex financially. </li> <li>Play a critical role in creating a pricing governance structure to ensure financial objectives and process excellence are both met while meeting challenging deadlines and expectations driven by the marketplace.</li> <li>Prioritize effectively and efficiently to meet internal and external customer needs.</li> <li>Respond to inquiries involving assumptions to ensure accuracy and precision.</li> <li>Support the presentation of information to Executive Leadership. Respond to questions in real-time in support of their review and approval.</li> <li>Participate in peer reviews of high complex data requests to validate that modeled data and related analytic deliverables match and satisfy business requirements.</li> <li>Assist in ad-hoc analysis. </li> </ul>The successful candidate will have a track record that demonstrates the following abilities: working successfully in a cross-matrix environment, adapting and performing in a dynamic and changing environment, developing and leveraging a comprehensive understanding of CVS Caremark’s enterprise assets, developing a deep understanding of internal and external assumptions, maintaining high levels of customer satisfaction, constantly striving to innovate and improve processes and applying financial and analytical expertise to make informed recommendations and decisions.Required Qualifications:<ul><li>5+ years professional experience process and change management, Financial modeling, financial analysis and/or program management.</li></ul>Preferred Qualifications: <ul> <li>Strong understanding of PBM or healthcare industry</li> <li>Experience working within matrix organization collaborating to create meaningful predictive analytics.</li> <li>Strong understanding of, or experience with, internal and external facing pricing and analytics teams.</li> <li>Ability to innovate, develop, and implement new products or solutions requiring collaboration with internal partners. Demonstrated success developing effective relationships with key internal partners across the enterprise.</li> <li>Working knowledge of relational databases and warehouses; SQL, Python or other reporting languages.</li> <li>Experience managing complex projects in a matrix environment.</li> <li>Ability to summarize complex financial analysis and support recommendations in presentations to Executive Leadership.</li> <li>Ability to work independently in a fast-paced environment and manage tight deadlines.</li> <li>Proficient in SQL and Microsoft Office.</li> </ul>Education:<ul><li>Bachelors Degree in a relevant discipline, such as finance, mathematics, business or other related field required or equivalent work experience.</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Manager, Assumptions Governance

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.Position Summary:The Senior Manager, Legal Contracts participates in the development and fulfillment of market conduct examination or state and federal investigation requests in support of Caremark’s PBM business. Evaluates market conduct matters and other regulatory requests and coordinates responses across various departments. Reviews and coordinates a variety of regulatory activities, performs legal research and analysis, and supports the Legal and Compliance groups in coordinating and tracking dispute matters, regulatory investigations and responses and market conduct exams.Responsibilities and Duties:<ul> <li>Develops a complex review and approval process to ensure deliverables meet rigorous legal and regulatory requirements.</li> <li>Directs teams to conduct risk assessments to mitigate potential risks associated with market conduct exams and regulatory inquiries and investigations.</li> <li>Determines potential legal, financial, or operational risks to develop risk mitigation strategies.</li> <li>Ensures that issues are triaged timely and aligned with the obligations of internal stakeholders. </li> <li>Establishes parameters to ensure transparency and clear communication throughout the examination or investigation process.</li> <li>Helps establish and implement the structure and processes to effectively track and manage market conduct and regulatory deliverables throughout their lifecycle.</li> </ul> Required Qualifications:7+ years of relevant professional work experience.5+ years of contract support or contract interpretation experience and/or 5+ years of healthcare, PBM or pharma experience. Preferred Qualifications: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.Certified Professional Contracts Manager (CPCM) preferred.Certified Federal Contracts Manager (CFCM) preferred.Education:Bachelor's degree required or equivalent years of relevant experience.Pay RangeThe typical pay range for this role is:$75,400.00 - $199,144.00 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. This position also includes an award target in the company’s equity award program. 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Legal Contracts - Senior Manager

TJ MaxxAt TJX Companies, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritizes your development. Whether you’re working in our four global Home Offices, Distribution Centers or Retail Stores—TJ Maxx, Marshalls, Homegoods, Homesense, Sierra, Winners, and TK Maxx, you’ll find abundant opportunities to learn, thrive, and make an impact. Come join our TJX family—a Fortune 100 company and the world’s leading off-price retailer. Job Description:Opportunity: Grow Your CareerResponsible for promoting an excellent customer experience. Oversees a team of Associates at front of store ensuring prompt, courteous customer service and promotion of loyalty programs. Leads by example by engaging and interacting with all customers, and maintaining a clean and organized store. Role models outstanding customer service.<ul> <li>Creates a positive internal and external customer experience</li> <li>Promotes a culture of honesty and integrity; maintains confidentiality</li> <li>Takes an active role in training and mentoring Associates on front end principles</li> <li>Trains and coaches Associates on personalizing the customer experience while promoting loyalty programs</li> <li>Assigns registers, supports and responds to POS coverage needs, and coordinates breaks for all Associates</li> <li>Addresses customer concerns and issues promptly, ensuring a positive customer experience</li> <li>Ensures Associates execute tasks and activities according to store plan; prioritizes as needed</li> <li>Communicates accurately and effectively with management and Associates when setting and addressing priorities; provides progress updates</li> <li>Provides and accepts recognition and constructive feedback</li> <li>Partners with Management on Associate training needs to increase effectiveness</li> <li>Ensures adherence to all labor laws, policies, and procedures</li> <li>Promotes credit and loyalty programs</li> <li>Supports and participates in store shrink reduction goals and programs</li> <li>Promotes safety awareness and maintains a safe environment</li> <li>Other duties as assigned</li> </ul>Who We’re Looking For: You.<ul> <li>Available to work flexible schedule, including nights and weekends</li> <li>Strong understanding of merchandising techniques</li> <li>Capable of multi-tasking</li> <li>Strong communication and organizational skills with attention to detail</li> <li>Able to respond appropriately to changes in direction or unexpected situations</li> <li>Team player, working effectively with peers and supervisors</li> <li>Able to train others</li> <li>1 year retail and 6 months of leadership experience</li> </ul> Benefits include: Associate discount; EAP; smoking cessation; bereavement; 401(k) Associate contributions; child care &amp; cell phone discounts; pet &amp; legal insurance; credit union; referral bonuses. Those who meet service or hours requirements are also eligible for: 401(k) match; medical/dental/vision; HSA; health care FSA; life insurance; short/long term disability; paid parental leave; paid holidays/vacation/sick; auto/home insurance discounts; scholarship program; adoption assistance. All benefits are provided in accordance with and subject to the terms of the applicable plan or program and may change from time to time. Contact your TJX representative for more information. In addition to our open door policy and supportive work environment, we also strive to provide a competitive salary and benefits package. TJX considers all applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, marital or military status, or based on any individual's status in any group or class protected by applicable federal, state, or local law. TJX also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. Applicants with arrest or conviction records will be considered for employment. Address:1035 North Main StreetLocation:USA TJ Maxx Store 0408 Warrington PAThis position has a starting pay range of $14.00 to $14.50 per hour. Actual starting pay is determined by a number of factors, including relevant skills, qualifications, and experience.

Customer Experience Coordinator

MarshallsAt TJX Companies, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritizes your development. Whether you’re working in our four global Home Offices, Distribution Centers or Retail Stores—TJ Maxx, Marshalls, Homegoods, Homesense, Sierra, Winners, and TK Maxx, you’ll find abundant opportunities to learn, thrive, and make an impact. Come join our TJX family—a Fortune 100 company and the world’s leading off-price retailer. Job Description:Opportunity: Grow Your CareerResponsible for delivering a highly satisfied customer experience proven by engaging and interacting with all customers, embodying customer experience principles and philosophy, and maintaining a clean and organized store environment. Adheres to all operational, merchandise, and loss prevention standards. May be cross-trained to work in multiple areas of the store in order to support the needs of the business.<ul> <li>Role models established customer experience practices with internal and external customers</li> <li>Supports and embodies a positive store culture through honesty, integrity, and respect</li> <li>Accurately rings customer purchases/returns and counts change back to customer according to established operating procedures</li> <li>Promotes credit and loyalty programs</li> <li>Maintains and upholds merchandising philosophy and follows established merchandising procedures and standards</li> <li>Accurately processes and prepares merchandise for the sales floor following company procedures and standards</li> <li>Initiates and participates in store recovery as needed throughout the day</li> <li>Maintains all organizational, cleanliness, and recovery standards for the sales floor and participates in the maintenance/cleanliness of the entire store</li> <li>Provides and accepts recognition and constructive feedback</li> <li>Adheres to all labor laws, policies, and procedures</li> <li>Supports and participates in store shrink reduction goals and programs</li> <li>Participates in safety awareness and maintains a safe environment</li> <li>Other duties as assigned</li> </ul>Who We’re Looking For: You.<ul> <li>Possesses excellent customer service skills</li> <li>Able to work a flexible schedule to support business needs</li> <li>Possesses strong communication and organizational skills with attention to detail</li> <li>Capable of multi-tasking</li> <li>Able to respond appropriately to changes in direction or unexpected situations</li> <li>Capable of lifting heavy objects with or without reasonable accommodation</li> <li>Works effectively with peers and supervisors</li> <li>Retail customer experience preferred</li> </ul> Benefits include: Associate discount; EAP; smoking cessation; bereavement; 401(k) Associate contributions; child care &amp; cell phone discounts; pet &amp; legal insurance; credit union; referral bonuses. Those who meet service or hours requirements are also eligible for: 401(k) match; medical/dental/vision; HSA; health care FSA; life insurance; short/long term disability; paid parental leave; paid holidays/vacation/sick; auto/home insurance discounts; scholarship program; adoption assistance. All benefits are provided in accordance with and subject to the terms of the applicable plan or program and may change from time to time. Contact your TJX representative for more information. In addition to our open door policy and supportive work environment, we also strive to provide a competitive salary and benefits package. TJX considers all applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, marital or military status, or based on any individual's status in any group or class protected by applicable federal, state, or local law. TJX also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. Applicants with arrest or conviction records will be considered for employment. Address:2783 Paper Mill RoadLocation:USA Marshalls Store 0845 Wyomissing PAThis position has a starting pay range of $12.00 to $12.50 per hour. Actual starting pay is determined by a number of factors, including relevant skills, qualifications, and experience.

Merchandise Associate

HomeGoodsAt TJX Companies, every day brings new opportunities for growth, exploration, and achievement. You’ll be part of our vibrant team that embraces diversity, fosters collaboration, and prioritizes your development. Whether you’re working in our four global Home Offices, Distribution Centers or Retail Stores—TJ Maxx, Marshalls, Homegoods, Homesense, Sierra, Winners, and TK Maxx, you’ll find abundant opportunities to learn, thrive, and make an impact. Come join our TJX family—a Fortune 100 company and the world’s leading off-price retailer. Job Description:Opportunity: Grow Your CareerResponsible for delivering a highly satisfied customer experience proven by engaging and interacting with all customers, embodying customer experience principles and philosophy, and maintaining a clean and organized store environment. Adheres to all operational, merchandise, and loss prevention standards. May be cross-trained to work in multiple areas of the store in order to support the needs of the business.<ul> <li>Role models established customer experience practices with internal and external customers</li> <li>Supports and embodies a positive store culture through honesty, integrity, and respect</li> <li>Accurately rings customer purchases/returns and counts change back to customer according to established operating procedures</li> <li>Promotes credit and loyalty programs</li> <li>Maintains and upholds merchandising philosophy and follows established merchandising procedures and standards</li> <li>Accurately processes and prepares merchandise for the sales floor following company procedures and standards</li> <li>Initiates and participates in store recovery as needed throughout the day</li> <li>Maintains all organizational, cleanliness, and recovery standards for the sales floor and participates in the maintenance/cleanliness of the entire store</li> <li>Provides and accepts recognition and constructive feedback</li> <li>Adheres to all labor laws, policies, and procedures</li> <li>Supports and participates in store shrink reduction goals and programs</li> <li>Participates in safety awareness and maintains a safe environment</li> <li>Other duties as assigned</li> </ul>Who We’re Looking For: You.<ul> <li>Possesses excellent customer service skills</li> <li>Able to work a flexible schedule to support business needs</li> <li>Possesses strong communication and organizational skills with attention to detail</li> <li>Capable of multi-tasking</li> <li>Able to respond appropriately to changes in direction or unexpected situations</li> <li>Capable of lifting heavy objects with or without reasonable accommodation</li> <li>Works effectively with peers and supervisors</li> <li>Retail customer experience preferred</li> </ul> Benefits include: Associate discount; EAP; smoking cessation; bereavement; 401(k) Associate contributions; child care &amp; cell phone discounts; pet &amp; legal insurance; credit union; referral bonuses. Those who meet service or hours requirements are also eligible for: 401(k) match; medical/dental/vision; HSA; health care FSA; life insurance; short/long term disability; paid parental leave; paid holidays/vacation/sick; auto/home insurance discounts; scholarship program; adoption assistance. All benefits are provided in accordance with and subject to the terms of the applicable plan or program and may change from time to time. Contact your TJX representative for more information.In addition to our open door policy and supportive work environment, we also strive to provide a competitive salary and benefits package. TJX considers all applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, marital or military status, or based on any individual's status in any group or class protected by applicable federal, state, or local law. TJX also provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.Address:1301 Skippack PikeLocation:USA HomeGoods Store 0294 Blue Bell PAThis position has a starting pay range of $12.00 to $12.50 per hour. Actual starting pay is determined by a number of factors, including relevant skills, qualifications, and experience.

Evening/Weekend Cashiers

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.Position SummaryWe are seeking an experienced medical professional to manage strategic initiatives, along with a team of medical coders/nurses supporting Aetna’s Special Investigations Unit.Key Responsibilities:<ul><li>Leadership: Leads a team of coding/nursing professionals who conduct reviews of medical records and claims for suspected healthcare fraud, waste, and abuse. Provides direction and counsel to support coders and progress reviews. Identification and implementation of key initiatives that support effective and efficient scalability along with meeting or exceeding ROI.</li></ul><ul><li>Team Management: Conducts team member evaluations and provides performance feedback to staff. Manages team’s caseload to ensure equitable distribution and exposure to wide range of reviews. Assist with business opportunities aligned to inventory allocation and prioritization.</li></ul><ul><li>Quality Control and Compliance: Maintains oversight of coder/nurse reviews, ensuring compliance with ICD-10, CPT and HCPCS coding guidelines. Assist with department build and implementation of SIU coding quality program.</li></ul><ul><li>Training: Assesses team’s training needs and works with SIU leadership on development plans for team members and SIU coding department. Contributes to the development and delivery of educational awareness and training programs that meet or exceed those required by state mandates. Coordinates ongoing trainings to educate team on updates or modifications to medical codes.</li></ul><ul><li>Presentations: Supports the team of coding/nursing professionals in presenting findings to internal and external stakeholders, including, but not limited to SIU Investigators, Aetna Plan Leadership, Law Enforcement, Legal Counsel, Providers, and State Regulators.</li></ul><ul><li>Collaboration: Develops and maintains close working relationships with Aetna Medical Directors, Nurses, and other clinical staff who conduct medical record reviews. Consults with clinical staff as needed to assist in reviews. Partnership with SIU leadership to deliver key initiatives dedicated to infrastructure build and stabilization.</li></ul>Required Qualifications and Skills:<ul> <li>Minimum of 8 years of experience in medical coding in an SIU setting with at least 5 years in a supervisory or management role.</li> <li>Strong knowledge of industry coding guidelines involving ICD-10, CPT and HCPCS codes.</li> <li>Ability to guide a team of coding professionals with differing levels of coding experience in a variety of medical specialties.</li> <li>Proficiency in Microsoft products including, but not limited to Word, Excel, Outlook, and PowerPoint.</li> <li>Experience in infrastructure build and design to include, but not limited to workforce modeling, efficiency identification and implementation resulting in demonstrated decrease in unit cost, inventory reporting, inventory allocation for Medicare, Medicaid and Commercial (fully insured and ASO) work product, development of standardized coding language, assist with operational dashboard development and execution of department action plans.</li> <li>Understanding of how to implement SIU coding quality programs, to include statistical sampling, IRR testing, building objective comprehension assessments for coding training and coding quality remediation plans.</li> <li>Ability to communicate to a wide range of stakeholders, adjusting the message as appropriate for the recipient(s).</li> <li>Proven experience in overseeing and executing operational projects.</li> <li>Potential to travel up to 10%, (dependent on business needs).</li> </ul>Preferred Qualifications:<ul> <li>Active Registered Nurse (RN) Licensure preferred</li> <li>Experience conducting audits of medical records to substantiate allegations of healthcare fraud, waste, and abuse.</li> <li>Experience leading a team of coding professionals who conduct reviews to substantiate allegations of healthcare fraud, waste, and abuse.</li> <li>Experience with Aetna or other MCO Commercial/Medicaid/Medicare plans</li> <li>Certified Professional Coder</li> </ul>Education:<ul><li>Bachelor's degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 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. This position also includes an award target in the company’s equity award program. 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Special Investigations Coding Manager (Aetna SIU)

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.How will this role have an impact?The Executive Assistant will support technology executives in their day-to-day schedule management, meeting preparation, expenses, and a number of ad hoc work-related projects. This person will be the gatekeeper for the VPs and will help them prioritize and communicate with internal and external stakeholders in a timely, professional manner.What will you do?<ul> <li>Supporting technology executives in day-to-day activities including the coordination and management of meetings and daily schedule.</li> <li>Coordinate meetings, including booking rooms, and preparation of materials</li> <li>Manage expenses and submit expense reports in Concur</li> <li>Coordinate travel arrangements</li> <li>Assist with team events across multiple sites</li> <li>Arrange and execute team building, offsites, and social events/lunches</li> <li>Liaise with Technology and facilities departments regarding software, equipment, and office needs</li> <li>Ad hoc projects as needed</li> </ul>We are looking for someone with:<ul> <li>3+ years of experience in a supporting role for c-level executive</li> <li>Experience using G-Suite</li> <li>Proven professional organizational and time management skills</li> <li>Excellent interpersonal skills</li> <li>Track record of problem solving and critical thinking</li> </ul>Education<ul><li>Bachelor's degree preferred/specialized training/relevant professional qualification.</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$22.59 - $58.85This 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Executive Assistant - Technology and AI

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.Position Summary The Enrollment Representative position will be supporting multiple health plans. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data. • Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; •Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.(*) • Monitors daily status reports assessing output for developing trends potentially impacting service levels. (*) • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) • Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization. (*) • Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). (*) • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. (*) • When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. (*) • Interprets and translates client benefits and supporting account structure against internal systems/applications(i.e.,GEBAR, AAS, and CCI). (*) • Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. • Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients. Required Qualifications <ul> <li>Attention to detail and accuracy.</li> <li>Problem solving skills.</li> <li>Strong organization skills.</li> <li>Understands the impact of work to other teams and downstream support areas.</li> <li>Ability to analyze and research data to make appropriate corrections as necessary.</li> <li>Strong verbal and written communication skills.</li> <li>Workplace flexibility - ability to adapt to change.</li> <li>Required to maintain work schedule within EST time zone (9:30am- 6:00pm EST).</li> <li>Ability to remain available for overtime, with possible weekend work where needed.</li> </ul> Preferred Qualifications <ul> <li>Knowledge of Health Care and/or MCO’s.</li> <li>Knowledge of Enrollment.</li> <li>Knowledge Medicaid and/or Medicare.</li> <li>Knowledge and comfortability with learning different systems and using Excel (VLOOKUP).</li> </ul> Education <ul><li>High School Diploma or equivalent.</li></ul> Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $28.46This 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. 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 peopleWe 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:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>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.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Eligibility Consultant

CompanyCox Communications, Inc.Job Family GroupSalesJob ProfileDirector, Channel Sales - RSManagement LevelDirector Flexible Work Option Can work remotely anywhere in the specified countryTravel %Yes, 50% of the timeWork ShiftDayCompensationCompensation includes a base salary of $126,000.00 - $210,000.00. The salary rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's experience. In addition to the salary range identified herein, this role is also eligible for an annual incentive/commission target of $100,000.00.Job DescriptionAt RapidScale, exceptional technology is powered by exceptional people. As a growing leader in secure, reliable managed cloud solutions, we help SMBs and enterprises alike simplify IT and unleash innovation. With a broad portfolio spanning AWS, Azure and Google to a full set of Private Cloud and Cybersecurity solutions, RapidScale helps companies turn technology into their biggest competitive advantage. As part of the Cox family of companies, we offer best-in-class benefits, a commitment to work-life balance, and an award-winning workplace experience.Are you a driven hunter with a passion for landing large, complex enterprise cloud deals? As a Principal Cloud Account Executive-Strategic Pursuits, you’ll lead the charge in identifying, pursuing, and closing RapidScale’s most strategic net-new opportunities. This role is built for a top performer who thrives on creating new relationships, breaking into tough accounts, and driving transformative IT outcomes through multi-cloud managed services. Your ability to prospect, influence the C-suite, and close high-value contracts sets you apart.What You’ll DoAs a Principal Cloud Account Executive-Strategic Pursuits, you will serve as a lead business development executive for enterprise cloud managed services. You’ll focus on net-new logo acquisition, deepen strategic partnerships, and represent RapidScale’s capabilities at the highest levels.Key responsibilities include:<ul> <li> Net-New Business Development: Identify, pursue, and win net-new enterprise clients with complex cloud managed service’s needs. Target companies with $500M–$5B+ in revenue and drive multi-year recurring revenue opportunities.</li> <li> Strategic Sales Execution: Own the full sales lifecycle for enterprise cloud deals with total contract values exceeding $10+ million. Execute a disciplined, account-based sales strategy that emphasizes value creation, executive alignment, and win planning, including surfacing and shaping opportunities around generative AI, machine learning, and data modernization</li> <li> Executive Engagement &amp; C-Suite Influence: Build and maintain trusted relationships with CIOs, CTOs, and other senior stakeholders. Guide strategic conversations that connect RapidScale solutions, including AI/ML and data-driven innovation, to growth, cost efficiency, and compliance outcomes.</li> <li> Complex Deal Structuring: Lead multi-party negotiations and structure sophisticated managed services contracts spanning cloud infrastructure, modernization, security, and compliance. Work cross-functionally with legal, finance, and delivery teams to close high-quality deals.</li> <li> Cloud Ecosystem Collaboration: Accelerate pipeline and reach by co-selling and partnering with hyperscalers (AWS, Azure, Google Cloud). Leverage joint go-to-market programs, incentives, and technical teams to improve win rates.</li> <li> Pipeline Leadership &amp; Forecasting: Maintain a strong pipeline of strategic enterprise opportunities, with disciplined forecasting and funnel management.</li> <li> Thought Leadership &amp; Market Presence: Represent RapidScale at executive briefings, customer innovation sessions, and industry conferences. Share insights on evolving trends and help position RapidScale as a differentiated cloud partner.</li> <li> Cross-Functional Leadership: Collaborate with product, architecture, marketing, and delivery teams to build compelling solutions and ensure a seamless transition from sales to implementation.</li> </ul>Minimum Qualifications<ul> <li> Experience &amp; Education: Bachelor's degree and 10+ years of enterprise sales experience. The right candidate could also have a different combination, such as a master’s degree and 8 years’ experience; a Ph.D. and 5 years’ experience or 14+ years enterprise sales experience.</li> <li> Enterprise Sales Performance: Experience selling to and influencing executive stakeholders in large enterprise accounts ($500M–$5B+ revenue), with demonstrated c-suite gravitas and executive presence.</li> <li> Hunter Mindset: Experience identifying, developing, and closing net-new enterprise accounts with long-cycle, high-value pursuits.</li> <li> Multi-Cloud: Experience across Private Cloud and Public Cloud environments, with a strong track record of structuring and closing complex hybrid multi-cloud enterprise deals in large-scale organizations.</li> <li> Complex Deal Experience: Demonstrated ability to lead and close enterprise cloud deals exceeding $10-50+ million in total contract value.</li> <li> Travel: Willing and able to travel up to 35–40% for executive meetings, on-site workshops, and industry events.</li> </ul>Preferred Qualifications<ul> <li>Familiarity with enterprise AI/ML workloads and how organizations are leveraging generative AI, large language models, and data platforms to transform operations and drive innovation.</li> <li>Deep understanding of cloud infrastructure, IaaS, PaaS, containerization, security, and compliance frameworks. Certifications such as AWS Solutions Architect, Azure Solutions Architect, or Google Cloud Professional Cloud Architect are preferred.</li> <li>Established executive network and relationships across enterprise verticals.</li> <li>Experience with co-selling and GTM programs via AWS, Azure, or Google Cloud.</li> <li>Familiarity with key industries such as Healthcare, Financial Services, SaaS, or Retail.</li> <li>Skilled in navigating matrixed organizations and building alignment across diverse business and technical stakeholders.</li> </ul>BenefitsThe Company offers eligible employees the flexibility to take as much vacation with pay as they deem consistent with their duties, the company’s needs, and its obligations; seven paid holidays throughout the calendar year; and up to 160 hours of paid wellness annually for their own wellness or that of family members. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Cox Communications is all about creating moments of real human connection; and for employees, that’s true both in the workplace and in the problems we solve for customers. From building advertising solutions to unleashing IoT technologies to creating an exceptional experience for customers in our retail locations and online, we’re creating a world that is smarter and more connected. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer – All qualified applicants/employees will receive consideration for employment without regard to that individual’s age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. <h3> </h3>Application Deadline:

112 Jobs in Pennsylvania