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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: As an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. In addition, as an Oncology Pharmacist you will assist front-line colleagues (i.e. Staff Pharmacists and Representatives) with oncology process/procedural support by acting as a subject matter expert and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education, continuing education and certification. This position also supports departmental leadership in identifying issues, concerns and trends within the workflow process. The Pharmacist will partner with our Lead Oncology Pharmacist to help develop/deliver formal clinical training sessions, delivering them to staff to enhance their clinical knowledge base in relation to the oncology disease states and therapies. Strong effective communication is required to ensure the thorough distribution, understanding and execution of required knowledge transfer to internal and external stakeholders. The Pharmacist will be expected to work closely with other teams and departments throughout the company including Case Review Unit (CRU), Commercial PA &amp; appeals, internal Medical Directors, Clinical Development, and our Client Liaison team. This is a work-from-home role open to qualified candidates within the United States. Candidate must be willing and able to work 9am-5:30pm EST M-F, with the ability to flex to later or earlier if needed for training, client meetings, or other business needs. PRIMARY DUTIES AND RESPONSIBILITIES: 1. Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design with a focus on oncology reviews. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval &amp; denial management processes. % Time: 70% 2. A Leader in identifying and solving issues, concerns and trends within the workflow process that need to be addressed at a higher level resulting in optimal performance and outcomes. Responsible for assisting front-line colleagues (i.e. Staff Pharmacists and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. % Time: 20% 3. Assist with standard or client specific oncology review process changes as needed. % Time: 5% 4. Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients. % Time: 5%EDUCATIONBS in Pharmacy or PharmDRequired: Licensed Pharmacist and Board Certified Oncology Pharmacist (BCOP) REQUIRED SKILLS &amp; OTHER MINIMUM REQUIRED QUALIFICATIONS: • Active pharmacist license in the state of residence that is in good standing.• Board Certified Oncology Pharmacist (BCOP) required • 2+ years clinical pharmacist experience, inclusive of prior authorization experience• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential. • Must be able to multitask and utilize multiple system applications simultaneously. • Must be able to utilize available resources independently and provide high quality work. • Must demonstrate problem solving ability and attention to detail. • Demonstrated clinical expertise in the oncology therapy arena, with recent career focus in the oncology area. • Ability to adapt and change with workflow and shifting priorities. • Ability to work effectively in a team environment and provide mentorship to front line staff on the PA team. • Must possess excellent written, verbal, grammar, and listening communication skills. • Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner. • Ability to maintain confidentiality of PHI (Protected Health Information). ESSENTIAL FUNCTIONS: 1. Regular and predictable attendance. 2. Colleague will be required to work mandatory overtime/extended work week when needed. 3. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.4. Adhere to all policies and procedures. 5. Attend on-going training and development meetings. Physical Requirements: 1. Sits at desk for long periods of time. 2. Talking on phone for extended periods of time. 3. Computer use for extended periods of time. 4. Reading a computer screen. WORK ENVIRONMENT: Work from an approved work-from-home location.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$45.43 - $101.54This 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: 05/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

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.Sr. Manager, Clinical AssumptionsPosition Summary:As Sr. Manager, Clinical Assumptions, you will join the Pharmaceutical Forecasting and Analysis team supporting the unified PBM Connected Ecosystem to drive accountability and accuracy across the Caremark Organization. The Sr. Manager, Clinical Assumptions will play a key role in developing, supporting and maintaining PBM Assumptions. In this role you will act as a subject material expert in the Clinical field driving accuracy in financial modeling of the Underwriting Ecosystem by connecting with Business Process Owners and Data Architects to emulate future member behavior with the financial modeling. Primary responsibilities include coordinating with Formulary Management to stay abreast of upcoming strategic changes and decode their financial impact, drive accurate modeling by providing clinical guidance when needed on therapeutic equivalencies or interchangeability, and act as a representative of the Client Financial Analysis and Optimization (CFAO) organization with Trade &amp; Medical Affairs as needed.Additionally, this position will:<ul> <li>Partner with Business resources to gather, refine and evaluate new clinical assumptions that influence the business.</li> <li>Foster strong relationships within the PBM Ecosystem to elevate accurate financial stewardship as it related to clinical assumptions.</li> <li>Support discussions that are highly complex.</li> <li>Drive results utilizing durable and automation focused solutions.</li> <li>Prioritize effectively and efficiently to meet internal and external customer needs.</li> <li>Support the translation market dynamics to usable business intelligence.</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>7+ years professional clinical and/or financials experience, preferably within a PBM or health plan</li> <li>1+ years experience working with health plans, employer clients, or coalitions/TPAs, with multiple lines of business with different funding arrangements.</li> <li>Able to travel up to 10% of the time.</li> </ul>Preferred Qualifications:<ul> <li>Expertise in Utilization Management and Formulary Management.</li> <li>Knowledge and experience with Microsoft applications (Excel, Power Point, Word, Outlook, Teams).</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>Knowledge of relational databases and warehouses, advanced SQL, VBA, OLAP and SAS skills.</li> <li>Experience managing complex projects in a matrix environment.</li> <li>Ability to summarize complex pharmaceutical findings 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>AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement.</li> <li>Previous PBM Pricing, Underwriting, Data analytics or Financial Analysis experience</li> </ul>Education:<ul> <li>BS Pharmacy or PharmD</li> <li>Licensed Pharmacist</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: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Manager, Clinical Assumptions

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 Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems.Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.- Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.- Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures.- Identifies and reports possible claim overpayments, underpayments and any other irregularities.- Performs claim rework calculations.- Distributes work assignment daily to junior staff.- Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- 18+ months of medical claim processing experience.- Experience in a production environment.- Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $42.35This 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.

Senior Claim Benefit Specialist

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 SummaryBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryHealth Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.<ul> <li>Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.</li> <li>Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.</li> <li>Fully understands the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.</li> <li>Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.</li> <li>Uses customer service threshold framework to make financial decisions to resolve member issues.</li> <li>Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).</li> <li>Utilizes all relevant information to effectively influence member engagement.</li> <li>Takes immediate action when confronted with a problem or made aware of a situation.</li> <li>Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.</li> <li>Identifies member needs beyond the initial inquiry by answering the unasked questions.</li> <li>Resolves issues without or with limited management intervention.</li> <li>Provides education to members to support them in managing their health.</li> <li>Responds quickly to meet customer needs and resolve problems while avoiding over-committing.</li> <li>Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.</li> <li>Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.</li> <li>Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.</li> <li>Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.</li> <li>Partners with other departments to deliver client specific presentations.</li> <li>Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.</li> <li>Works collaboratively with colleagues to deliver the best customer experience Seeks to understand the customer, including circumstances, problems, expectations and needs.</li> <li>Asks probing questions to identify the underlying customer needs.</li> <li>Appropriately transitions conversations to explore possibilities for extending customer interactions.</li> <li>Guides members to the appropriate health resource Offers alternatives where appropriate.</li> <li>Acts with the best interest of customer in mind and central to all interactions.</li> <li>Collaborates with colleagues and co-workers to deliver a world class customer experience.</li> <li>Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.</li> <li>May participate in preparation and presentation of client specific presentations.</li> <li>May track and trend data.</li> <li>Coaches, trains and assists in the development of call center staff, as required.</li> <li>Participates in and/or leads special projects/initiatives addressing service issues, as necessary.</li> <li>Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.</li> <li>Delivers internal quality reviews.</li> <li>Provides appropriate support in third party audits when required.</li> <li>Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.</li> </ul> Required Qualifications<ul> <li>Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.</li> <li>Effective organizational skills and ability to manage multiple tasks.</li> <li>Effective communication skills, both verbal and written</li> <li>Experience working with computers Education High School Diploma </li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $25.65This 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: 05/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Health Concierge

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 We are seeking a highly skilled and experienced Security Engineer to join our Secure Collaboration Team. The successful candidate will be responsible for maintaining and enforcing security policies for various collaboration platforms, including SharePoint, OneDrive, Teams, Slack, SFTP, eShare, and related capabilities. This role will play a critical part in ensuring the security and compliance of these platforms while supporting the organization's overall secure sharing strategy.Primary Job Duties &amp; Responsibilities<ul> <li>Develop, implement, and maintain security policies for collaboration platforms, like M365, Teams, Slack, and SFTP, ensuring alignment with corporate security standards and regulatory compliance requirements.</li> <li>Oversee user access controls, identity management, and permission policies for collaboration platforms to ensure the least privilege access model.</li> <li>Conduct regular risk assessments and vulnerability assessments for collaboration platforms and implement necessary risk mitigation controls.</li> <li>Work with internal teams to integrate collaboration platforms into the enterprise security infrastructure, ensuring secure configuration and setup.</li> <li>Educate employees on best practices for secure usage of collaboration platforms, promoting a culture of security awareness within the organization.</li> <li>Work closely with IT, compliance, and business teams to ensure security requirements are met and any security concerns are addressed promptly.</li> <li>Develop and maintain collaboration dashboards and KPI reports in PowerBI to continuously monitor usage and trends of various collaboration platforms.</li> <li>Track and report usage of unsanctioned file sharing tools and cloud storages, support documentation of security incidents, response actions, and lessons learned.</li> <li>Stay up to date with security features and tools available for platforms like M365, Teams, eShare, Slack, and SFTP, and leverage them to enhance platform security.</li> <li>Create and maintain Azure Runbooks using PowerShell scripts, and automation using PowerApps.</li> <li>Continuously drive a simplified, consistent user experience at points of service engagement.</li> </ul>Required Qualifications<ul> <li>5+ years of experience in a security engineering or administration of collaboration platforms such as SharePoint, OneDrive, Teams, Slack, and cloud sharing tools.</li> <li>3+ years of experience with data at rest and data in motion encryption and other data protection techniques in cloud environments.</li> <li>2+ year of experience with automation of apps utilizing PowerApp.</li> <li>2+ year of experience in cloud sharing security configuration of M365 services and Azure.</li> <li>2+ year of experience with PowerBI and Azure Runbooks using Powershell.</li> </ul> Preferred Qualifications<ul> <li>Experience with eShare collaboration platform.</li> <li>Experience with secure file access and transfer protocols (SFTP).</li> <li>Excellent problem-solving skills and ability to work independently and collaboratively in a fast-paced environment.</li> <li>Strong communication skills to articulate security risks, solutions, and best practices to non-technical stakeholders.</li> <li>Demonstrated experience working with a wide range of internal and external stakeholders at all levels on strategic and operational information security programs.</li> <li>Strong analytical skills and the ability to understand and solve complex problems</li> <li>Experience in documenting and implementing procedures and guidelines.</li> <li>Continuous learner well informed on technology trends, tools, methodologies, and models.</li> <li>Ability to manage a high degree of complexity and distill information that provides clear direction.</li> <li>Comfortable operating within areas of ambiguity to iterate and make progress in a consistent manner.</li> <li>Agility to deal with a constantly changing business environments.</li> </ul> Education<ul><li>Bachelor’s degree or equivalent experience (High School Diploma and 4 years relevant experience)</li></ul>BUSINESS OVERVIEWBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunitiesAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$101,970.00 - $203,940.00This 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: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Security Engineer - Secure Collaboration

Are you someone who never rests on their laurels, always strives to go above and beyond, and is committed to keeping your PROMISES? Do you appreciate a company culture that is open, fosters work-life balance, and a dynamic team environment? Then Old Dominion is the home for you. We take pride in being the best in the industry, and from our humble beginnings we know that our People and our Family Spirit are the main ingredient in our secret sauce to success. At Old Dominion we are looking for individuals to join the OD Family that will provide innovative solutions and exceed expectations to keep OD the premier transportation solutions provider.Oversee and document the design and development of Middleware solutions that meet business and project needs using choice tools, providing expertise to, and coordinating efforts with internal and external customers.Primary Responsibilities<ul> <li>Implementation, administration, and configuration of Middleware functionality using the selected software and tools. (e.g., Oracle SOA Middleware, Hazelcast, etc.)</li> <li>Monitoring, troubleshooting, and resolving production support incidents.</li> <li>Troubleshoot performance and availability issues in a highly available environment.</li> <li>Perform research, analysis, design, and implementation of technical solutions to meet current and future user requirements.</li> <li>Provide level 2 and level 3 support in resolving incidents, establishing urgency of the problem, and owning the problem through resolution, keeping the client informed of progress.</li> <li>Project responsibilities in all or some of the following areas: project planning, work plan development, testing plan development and staffing.</li> <li>Provide technical assistance on projects throughout the environment.</li> <li>Assure technical and support documentation is complete and up to date.</li> <li>Provide technical assistance and work direction to aid other employees.</li> <li>Perform capacity planning and optimization for systems and services.</li> <li>Act as liaison between hosting provider and application development team regarding the web tier for setup and support of web sites.</li> <li>Act as senior developer on software development projects with responsibility for overall delivery of software components.</li> <li>Mentor less experienced Middleware Programmer Analysts and assist with questions and issues.</li> </ul>Job QualificationsEducation:<ul><li>Associate degree in Computer Science or related field or equivalent education and work experience</li></ul>Experience:<ul> <li>10+ years of experience in web services, application development and large-scale software implementations</li> <li>8+ years of experience developing web services (SOAP/REST) and Java/J2EE application development preferred</li> <li>5+ years of experience in application development using Java &amp; J2EE</li> <li>Proven experience with the administration and support of a SOA infrastructure.</li> <li>Experience installing, configuring, and supporting middleware tools.</li> <li>Experience with relational database technologies (DB2, SQL).</li> <li>Experience in LINUX and Windows.</li> <li>Strong analytical/troubleshooting skills.</li> <li>Self-motivated team player to take ownership of projects without much supervision.</li> <li>Ability to work within standard and change management processes</li> </ul>Compensation Range:The referenced salary range is based on the Company's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. ($139,078-$173,826)Working Days:Shift and hours to be determined.Working Shift:Shift and hours to be determined.Work Days and Shift are estimates and are subject to change, at any given time, based on job scheduling and/or business levels. Any information listed regarding Days and Shifts shall be considered a guideline of expectations for the specific position at the time of posting.Application Window:OngoingCandidates are encouraged to apply as soon as possible. Old Dominion plans to screen candidates, conduct interviews, and proceed with hiring candidates to meet its business needs, which may result in filling the role before the current anticipated application window closes.Join the OD Family Today! As a Full Time member of our Family, you and your family are eligible to receive:<ul> <li>Great Health Benefits including a Zero premium medical plan for employee only coverage</li> <li>Vision &amp; Dental</li> <li>Short Term &amp; Long Term Disability</li> <li>Flex Spending Accounts</li> <li>401k Retirement plan with company match and additional company annual discretionary match opportunity</li> <li>Life Insurance</li> <li>Wellness Program</li> <li>12 Days Paid Time Off</li> <li>9 Paid Holidays including a birthday holiday</li> <li>Training and growth opportunities to build a career</li> <li>We prioritize our OD family of employees</li> <li>Ability to advance through our promote from within philosophy</li> <li>National Career Opportunities Available at our 260+ service centers</li> </ul>Old Dominion Freight Line, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, and/or gender expression, sexual orientation, age, disability, pregnancy, genetic information, military status, Vietnam Era and/or veteran status, or any other characteristic protected by applicable law(s).If you have questions regarding this posting or require assistance with the application process, please <a href="https://www.odfl.com/us/en/contact.html" target="_blank">click here</a> for contact information.

old-dominion-freight-line

Middleware Developer lll

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 SummaryAetna, a CVS Health company has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy &amp; Operations) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. The Primary Responsibilities of the Medical Director include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will: ◾Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. ◾Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests.◾Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. ◾ Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. ◾Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. ◾Work Collaboratively with the functional areas. Required Qualifications*Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. *M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Preferred Qualifications* Health plan/payor experience. * Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Strong communication skills both written and verbal. Education* M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experiencePay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 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: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Medical Policy & Operations)

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<ul><li> Oversees account management for an assigned book of business for products and services in support of profitable growth and other business objectives within the Professional Employer Organization (PEO) segment. Support strategic business plans for accounts and customer relationships, focusing on revenue growth, member retention, and achievement of financial objectives. What you will do <ul> <li>Under general supervision, manages the operations of an assigned book of business, ensuring high levels of customer satisfaction, retention, and account growth.</li> <li>In collaboration with the Account Executive and leadership, develops complex account plans and strategies to maximize customer relationships, mitigate risks, and achieve superior customer service.</li> <li>Conducts routine business reviews with clients, identifying areas for improvement, and making recommendations to optimize account outcomes.</li> <li>Collaborates with internal stakeholders, such as operations, marketing, and product teams, to align account strategies, deliver value-added solutions, and enhance customer experience.</li> <li>Designs and delivers client presentations and reports to showcase account stewardship, highlight opportunities, and drive engagement.</li> <li>Implements proactive account management and customer support, addressing client inquiries, resolving issues, and ensuring a smooth and positive client experience</li> <li>Collaborates with cross-functional teams to ensure timely and accurate delivery of client projects, products, and services, meeting client expectations and driving customer satisfaction.</li> <li>Identifies and assesses risks within client accounts, developing mitigation strategies and action plans to proactively address challenges and ensure long-term success.</li> </ul> Required Qualifications<ul> <li>3-5 years work experience in Account Management, client facing (Employee Benefits).</li> <li>Possess excellent problem solving and decision making skills.</li> <li>Proficiency in Microsoft Office, Excel, TEAMs and PowerPoint.</li> <li>Health Insurance license (or must obtain within 90 days of hire).</li> <li>Ability to travel 10-15% nationally.</li> <li>Strong communication skills, verbal and written.</li> <li>C-Suite experience.</li> </ul> Preferred Qualifications<ul> <li>Aetna system and/or product knowledge a plus.</li> <li>Comfortable in conducting formal or informal presentations.</li> <li>Strong organizational and time management skills.</li> <li>Industry experience in Professional Employer Organizations.</li> </ul> Education<ul><li>Bachelor’s degree or equivalent experience (HS diploma + 4 years relevant experience).</li></ul> </li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $91,800.00This 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: 07/03/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Account Manager - Professional Employer Organization

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.Senior Epic Analyst​: 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. Title: Senior Epic Analyst Department: Information Technology/Health Information Management Reports To: Epic Team Lead/Manager Summary: The Senior Epic Analyst is a subject matter expert in Epic systems, responsible for leading complex projects, providing advanced technical support, and mentoring junior analysts. This role involves in-depth analysis, design, and implementation of Epic system solutions to optimize workflows, enhance patient care, and improve operational efficiency. The Senior Epic Analyst serves as a key resource for troubleshooting complex issues and driving system improvements. Responsibilities: <ul> <li>Provide end-user support, analyzes and diagnoses system problems, identifies root cause, and then solves the problem or escalates issues to other appropriate IT staff when outside area of responsibility or expertise.</li> <li>Partners with vendor to troubleshoot and resolve system problems, to improve product performance and usability. Provides vendor with recommendations for system improvements.</li> <li>Addresses technical issues that occur during installation and maintenance activities.</li> <li>Designs, implements, and supports applications while ensuring ongoing optimization and performance.</li> <li>Translates technical requirements into development specifications and provides product management support.</li> <li>Evaluates and documents system updates, upgrades, and their impacts in collaboration with analysts and end users.</li> <li>Participates in system implementations, upgrades, and continuous improvement initiatives.</li> <li>Conduct system testing, validation, and quality assurance to ensure compliance and optimal system performance.</li> <li>Develop and maintain documentation, including build specifications, test scripts, and training materials, including the delivery of training when necessary.</li> <li>Partner with clinical staff and IT professionals to evaluate, design, develop, test, implement, and maintain systems</li> <li>Partner with clinical staff and IT teams, to ensure workstations, printers, scanners, mobile devices, and other peripherals are aligned with the functional and compatibility requirements of Epic applications.</li> <li>Strategically lead and collaborate on cross-functional application initiatives with application and operational teams to ensure seamless integration, streamlined workflows, and optimal system performance.</li> <li>Maintain vendor certifications required to support the analyst’s application areas of responsibility.</li> <li>Support system integrations and interoperability efforts with other third-party applications and interfaces.</li> <li>Assisting as needed with after hour activities such as go lives, upgrades, downtimes, and other special project.</li> </ul> Scope and Level <ul> <li>Guidelines: Demonstrates comprehensive knowledge and mastery of advanced concepts, practices, and procedures within a specialized field. Applies this expertise to innovate and drive improvements.</li> <li>Complexity: Duties and tasks are highly varied and complex, often involving significant responsibility. Procedures, methods, and techniques to carry out work are not well defined, requiring sophisticated analysis and strategic thinking.</li> <li>Decision Making: Exercises substantial discretion in making critical decisions. Decisions and recommendations are made after thorough analysis, leveraging independent judgment and ingenuity. Handles complex and high-impact decisions autonomously, escalating only the most critical issues to senior leadership.</li> <li>Communication: Communicates complex and interpretive information effectively across all levels of the organization, including team members, peers, management, clients, and the public. Utilizes discretion and independent judgment in information exchange, gathering, and presentation. Provides guidance and leadership in communication strategies.</li> <li>Adaptability/Flexibility: Demonstrates exceptional flexibility and adaptability in response to evolving business needs and changing environments. Proactively anticipates and addresses challenges.</li> <li>Critical Thinking: Exhibits a high level of open-mindedness and analytical skills, examining ideas and concepts from multiple perspectives to drive innovative solutions.</li> <li>Dependability: Takes ownership of work activities with a commitment to accuracy, efficiency, and timely completion. Sets a standard for reliability and accountability within the team.</li> <li>Initiative: Recognizes and undertakes assignments or tasks that need to be completed, actively seeks out additional responsibilities, and supports others in achieving their goals.</li> </ul> Qualifications Minimum <ul> <li>Education: Bachelor's degree is required or equivalent experience.</li> <li>Experience: Minimum of three (3) years of related experience is required.</li> <li>Equivalency: Combination of post-high school education, job related certification and/or related experience equivalent to seven (7) years may be considered in lieu of minimum requirements.</li> <li>Certification(s): Two or more of the following Epic Certifications:</li> <li>EpicCare Ambulatory, Healthy Planet, Beacon, Willow, Prelude, Cadence, Resolute Professional Billing, HIM (Health Information Management), MyChart, Beaker, Welcome Kiosk, Rover, Haiku, EpicCare Link, Caboodle, SlicerDicer, Bridges, Reporting Workbench, Orders</li> </ul> Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$79,310.00 - $158,620.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li> Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://urldefense.com/v3/__https://jobs.cvshealth.com/us/en/benefits__;!!GAh89RXEB34!MxHAIzPTpKgJekyDxJMVP0Lx8lb9fJSdh-SnwjW9zrWjIee7VSmyAHyliDVOpp_tj5a5k6sIGYCKMoAF96bAqrWXpKjFxA$" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a> We anticipate the application window for this opening will close on: 08/04/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$101,970.00 - $203,940.00This 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: 12/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr. Epic Analyst

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 Clinical Pharmacist is an operation-based role that conducts criteria based &amp; clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed.This position is responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education.Responsibilities:1.) Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval &amp; denial management processes. 2.) Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.3.) Responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership.4.) Assist with standard or client specific oncology review process changes as needed. 5.) Assist with writing Work Instructions when needed.6.) Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.7.) Provide feedback of trends pertinent to oncology reviews.8.) Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.9.) Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.This is a remote role, open to qualified candidates within the United States.Essential Functions: 1. Regular and predictable attendance2. Colleague may be required to work mandatory overtime/extended work week when needed3. Colleague may be required to travel when needed4. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.5. Adhere to all policies and procedures6. Attend on going training and development meetingsPhysical Requirements:1. Sits at desk for long periods of time (up to 100%)2. Talking on phone for extended periods of time (up to 100%)3. Computer use for extended periods of time (100%)4. Reading a computer screen (up to 100%)5. Light lifting of less than 10 lbsWork EnvironmentColleague is responsible for maintaining a HIPAA-compliant remote workspace. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access. Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)Education: BS in Pharmacy or PharmD requiredBoard Certified Oncology Pharmacist (BCOP) requiredActive, unrestricted pharmacist licensure in state of residence requiredRequired Skills &amp; Other Minimum Required Qualifications: <ul> <li>Licensed Registered Pharmacist</li> <li>Board Certified Oncology Pharmacist (BCOP) required</li> <li>2+ years clinical pharmacist experience, inclusive of prior authorization experience</li> <li>Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.</li> <li>Must be able to multitask and utilize multiple system applications simultaneously.</li> <li>Must be able to utilize available resources independently and provide high quality work.</li> <li>Must demonstrate problem solving ability and attention to detail.</li> <li>Ability to adapt and change with workflow and shifting priorities.</li> <li>Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the PA team.</li> <li>Must possess excellent written, verbal, grammar, and listening communication skills.</li> <li>Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.</li> <li>Ability to maintain confidentiality of PHI (Protected Healthcare Information).</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$45.43 - $101.54This 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: 05/12/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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