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Bring 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 Summary <h3>Accountable for driving innovation and operational excellence from ideation to delivery for small to moderate scale, complex, high value initiatives and parts of larger initiatives that impact the delivery of products and services to the internal and external environment.</h3> <ul> <li><h3>Evaluating, designing, and implementing new growth strategies</h3></li> <li><h3>Partnering cross-functionally to identify colleague and customer needs and develop solutions and tactics to drive growth</h3></li> <li><h3>Tracking progress against key milestones, and creating and implementing value-based metrics and analysis to measure outcomes</h3></li> <li><h3>Delivering quantitative and qualitative analyses with slide presentations and storytelling that will simplify complex problems into simple for solutions for leadership to weigh in on</h3></li> <li><h3>Assisting in creating executive level readouts and presentation materials for leadership</h3></li> <li><h3>Developing dashboards to be leveraged by key stakeholders to monitor performance of our business</h3></li> <li><h3>Conducting deep dive analytics to identify opportunities for innovation and process improvement</h3></li> <li><h3>Performing root cause analysis and ad hoc research to diagnose gaps in our workflow and patient experience</h3></li> <li><h3>Simplifying complex datasets and identifying actionable insights that drive value</h3></li> </ul> <h3>This job might be for you if:</h3> <ul> <li><h3>You're energized by being part of a large cross functional team working in a fast-paced environment. You enjoy working in teams with a diverse set of experiences and backgrounds. You listen to others’ ideas with an open mind.</h3></li> <li><h3>You’re a leader. And you know this means more than leading people. You know that it means taking initiative with a project - anticipating the next steps and taking action before asked. You also know that it can mean leading from behind and stepping in with much needed support.</h3></li> <li><h3>You enjoy solving complex problems. If you don’t know how to do something, you work to find the answers. You don’t get frustrated easily when something doesn’t go the way you planned.</h3></li> <li><h3>You can take complicated concepts and communicate them effectively to a variety of audiences. You write well. You pay attention to the details. You can articulate your thoughts eloquently. You have a track record of successfully influencing senior leadership and clients.</h3></li> <li><h3>You are self-motivated. You take ownership of your work and your team’s work. You pay attention to the details. </h3></li> <li><h3>You enjoy spending your weekends reading the health section of the paper or listening to healthcare podcasts. You’re interested in tracking how the industry is evolving and like understanding the intricacies of it.</h3></li> <li><h3>You love numbers and can track a multitude of key operational and financial metrics with ease</h3></li> <li><h3>You “think big” and encourage others to take calculated risks in exploring unconventional ideas and challenging the status quo</h3></li> </ul> <h3> Required Qualifications </h3> <ul> <li><h3>7+ years of experience in healthcare in a role that involves strategic problem solving and/or new product development (e.g., consulting)</h3></li> <li><h3>7+ years of demonstrated organizational skills (e.g. project management experience or managing cross-team/department initiatives with demonstrated success)</h3></li> <li><h3>5+ years of data analytics experience working with large data sets and using Excel, SQL, Python, and/or other equivalent analytics tools</h3></li> <li><h3>5+ years leading cross-functional teams in a matrixed environment</h3></li> </ul> <h3> Preferred Qualifications </h3> <ul> <li><h3>Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.</h3></li> <li><h3>Demonstrated leadership with relevant initiatives: Business process, enterprise business project strategic planning and analysis, risk management, public health, process improvement (e.g., Lean Six Sigma certification).management/consulting. </h3></li> <li><h3>Demonstrated superior business process, project management.</h3></li> <li><h3>Demonstrated experience successfully implementing change in complex organizations.</h3></li> <li><h3>Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity.</h3></li> </ul> <h3>Education</h3> <ul><li><h3> Masters degree preferred, but not required. Bachelor's degree required or equivalent experience.</h3></li></ul> Pay RangeThe typical pay range for this role is:$82,940.00 - $182,549.00 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 02/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Senior Manager Project Management

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 Customer Service Supervisor (Meritain Health) typically:<ul> <li>Develops, motivates, evaluates, and coaches staff on work procedures, proper call handling, and teamwork to deliver excellent customer service.</li> <li>Maintains a visible presence and is available to staff to answer questions, monitor calls, and give ongoing feedback.</li> <li>Utilizes available incentive programs to reward, recognize, and celebrate team and individual successes.</li> <li>Assesses individual and team performance on a regular basis, and provides candid and timely feedback regarding developmental training needs; includes completion of monthly and annual scorecards.</li> <li>Monitors all performance metrics, such as daily stats and schedule adherence; allocates resources to meet volume and performance demands.</li> <li>Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.</li> <li>Removes barriers to job performance and ensures regulatory compliance.</li> <li>Attracts, selects, and retains high caliber, diverse talent, able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.</li> <li>Acts as liaison between staff and other areas, including management, communicating workflow results, ideas, and solutions.</li> <li>Proactively analyzes constituent data, identifying trends and issues. Recognizes and acts on the needs to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.</li> <li>Effectively applies and enforces Aetna HR (Human Resources) policies and practices, i.e., FML (Family Medical Leave)/EML (Extended Medical Leave), Attendance, Code of Conduct, Disciplinary Guidelines, etc.</li> <li>All other duties as deemed necessary to the job function.</li> </ul>Required Qualifications<ul> <li>2 years of experience supporting a claim and/or customer service team in a production-based environment.</li> <li>Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).</li> <li>Ability to work five 8-hour shifts from Monday-Friday between 8am-7:30pm EST. </li> </ul>Preferred Qualifications<ul> <li>Acutely organized and able to effectively prioritize daily workload.</li> <li>Previous experience in the healthcare industry.</li> <li>Previous experience with self-funded or fully insured health care, sales, account management, or TPA (Third-Party Administrator) experience. </li> </ul>Education High school diploma or GED.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $102,081.00This 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: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Customer Service Supervisor (Meritain Health)

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.As a Senior Product Manager at CVS Health, in our "Analytics &amp; Behavior Change" group, you will be on the front line of driving innovation and directly impacting business decisions. This role is part of a team that works across the Pharmacy Benefits Management ecosystem building analytical cloud-based products, supporting pharmaceutical forecasting and pricing. You will have a chance to modernize legacy systems using cutting edge technology, to bring in accuracy and efficiency by using data science and AI. You will work with teammates from our business groups, data science, data engineering, and application development, as well as with your peers from partner product owners. you will be developing components of a software product that serves financial users from our Pharmacy Benefit Manager (PBM) business unit. You will work on multiple components of Data and Forecast Mart (DFM) and Computation Engine (CE) application, where data resides on GCP thru multiple sources and egressed to Azure for forecasting and modeling. The products we are building have a strong forecasting, what-if scenario, and financial component to them.What is your role:<ul> <li>Leading a team responsible for digital product development by defining strategy, vision, product roadmaps, prioritizing feature development, collaborating with stakeholders, and ensuring successful product launches.</li> <li>Overseeing the entire product lifecycle, including user research and interview, requirements gathering from various stakeholders/SMEs, end to end architecture/design, development, testing, integration, and iteration.</li> <li>Working across the organization to align product strategies with business goals, manage stakeholders, and facilitate effective collaboration between product teams and other departments to drive product success and customer satisfaction.</li> </ul>What you will be doing:<ul> <li>Identifying new opportunities, assessing the company’s product performance, and helping develop its long-term strategic plans for future product lines.</li> <li>Establishing the efficient user research, requirement management, prioritization, and delivery of the digital product roadmap to successfully enhance the company's brand recognition and competitive advantage in the industry.</li> <li>Developing technology and product roadmaps to provide visibility of risk and improvement options to maintain a proactive attitude among the digital product team.</li> <li>Analyzing qualitative and quantitative data to influence product features and prioritization to successfully deliver value to the users and company.</li> <li>Facilitating continuous and cross-communication across functional units and stakeholder groups, establishing relationships with collaborators at every organizational level.</li> <li>Defining strategy for product iterations, schedules, releases, and roadmaps to maintain speed to market and differentiation.</li> <li>Discovering, designing, and documenting business requirements and make sure that data scientists, data engineers, QA Engineers, BI engineers, and application developers have enough information to deliver high-value software code.</li> <li>Working with users, business product owners (BPO), release managers and other stakeholders towards requirements and prioritizing features along with synchronizing the release plans across multiple products.</li> <li>Organizing/leading meetings for collaboration and process implementations, status reporting and presentations, supporting resource and budget management.</li> </ul>Required Qualifications :<ul> <li>10+ years of work experience in Software Development projects.</li> <li>5+ years of Product Management experience.</li> <li>5+ years of Agile development methodology.</li> <li> 4+ years' experience working cross-functionally with Engineering or Data Science teams and familiarity with Data Science concepts.</li> <li>1+ year of hands-on experience with any programming language.</li> <li> Proven track record of managing all aspects of a successful analytics product throughout its lifecycle </li> <li>Exceptional communication skills to ensure all stakeholders understand and are aligned with the product plan.</li> <li>Adept at collaboration and teamwork</li> <li>Mastery of problem solving and decision-making skills</li> <li>Ability to thrive in a highly collaborative, fast-paced environment where the nature of the work can be varied</li> </ul>Preferred Qualifications :<ul> <li>History of providing data-based experiences to customers that make the complex understandable.</li> <li> Deep knowledge of various types of Healthcare data, including strong grasp of data nuances, common use cases, and limitations, with experience in common analytics tools </li> <li>experience with forecasting, what-if scenario planning, and financial analysis.</li> <li>Technical hands-on experience with SQL, Cloud based Architecture, PySpark, Python.</li> <li>Any data analytics experience is big plus.</li> </ul>Education :<ul><li>Bachelors degree required</li></ul>Pay RangeThe typical pay range for this role is:$106,605.00 - $284,280.00 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: 04/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Analytics Product Manager - Remote

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 a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a leading health insurance organization. This role is ideal for a data professional with strong skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory &amp; compliance reporting. This is an individual contributor role. Job responsibilities include:<ul> <li>Write robust, efficient code in SQL and Python to extract, manipulate, and analyze large healthcare datasets.</li> <li>Design, develop, and maintain complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity.</li> <li>Prepare timely and accurate Medicaid regulatory &amp; compliance reports in accordance with prescribed guidelines and standards.</li> <li>Communicate messages based on data analyses, including preparing easy-to-understand visualizations and other related documents for diverse audiences </li> <li>Collaborate with SIU investigators, Program Integrity Manager, and Compliance to understand business processes and translate them into actionable data requirements.</li> <li>Develop and participate in presentation and consultation with business partners on data, capabilities and performance results</li> <li>Identify data quality issues, perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity.</li> <li>Document data logic and methodology used in analyses and ensure reproducibility and transparency of results.</li> <li>Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.</li> </ul>This is a work-from-home position in the US. supporting standard east coast business hours. Required Qualifications<ul> <li>3+ years of experience in data analytics or data science, preferably in healthcare, health insurance, or Medicaid programs</li> <li>Ability to distill complex data into meaningful insights and present findings to non-technical audiences.</li> <li>Solid understanding and experience interpreting medical claim data</li> <li>Advanced experience in SQL coding sourcing from a data warehouse</li> <li>3+ years of data interpretation and analysis experience</li> <li>3+ years of project leadership experience</li> <li>Strong business as well as systems knowledge</li> <li>Excellent problem-solving, critical thinking, and written communication skills</li> <li>Advanced experience in Excel </li> </ul> Preferred Qualifications<ul> <li>Experience in healthcare fraud, waste and abuse </li> <li>Proficiency in Python coding</li> <li>Knowledge of Medicaid healthcare claims adjudication (QNXT) &amp; regulatory reporting</li> <li>Experience with data visualization tools (e.g., Tableau, Power BI</li> <li>Familiarity with Big Query &amp; Jupyter Notebook</li> </ul> Education<ul><li>Bachelor’s degree or equivalent experience</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $145,860.00This 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, SIU Data Analysis (SQL/Python)

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 Research and process grievances and appeals for Dual eligible members and providers. Perform outreach to obtain additional information. Interact with Medical Directors and Nurses as well as Leadership. Required Qualifications<ul><li>1 year of experience processing health insurance grievance and appeal cases.</li></ul> Preferred Qualifications<ul><li>6+ years of experience Medicare and Medicaid appeal and grievance preferred</li></ul> Education<ul><li>High School Diploma or GED required</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$21.10 - $44.99This 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: 06/04/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Complaint and Appeals Analyst - Fully Remote

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>Network implementation manager.</li> <li>Configure custom, domestic, and direct-to-employer networks. </li> <li>Subject matter expert for network files, network IDs, and PPO codes.</li> <li>User Acceptance Testing for new implementations and issue resolution.</li> <li>Performs research for network issues and partners with EDI IT on resolution.</li> <li>Coordinates custom online provider directories.</li> </ul> Required Qualifications<ul> <li>2+ years healthcare industry experience.</li> <li>1+ year network operations or provider relations experience.</li> <li>Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.).</li> </ul>Preferred Qualifications<ul> <li>1+ year of implementation management experience</li> <li>1+ year of vendor management experience</li> </ul> Education<ul><li> High School Diploma or GED</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $122,400.00This 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: 05/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Network 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 Operations Advisor is a client facing role that collaborates with Health Plan Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan. The Clinical Operations Advisor works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines.The Clinical Operations Advisor designs the clinical setups using Caremark technology solutions and supports the coding teams in the loading of clinical data into the adjudication system. The Clinical Operations Advisor partners with account team members to document clinical design best practices, provide input to streamline processes, and identify opportunities to improve the efficiency and accuracy of clinical setups. The Clinical Operations Advisor supports internal and client audits of clinical setups within adjudication systems, which includes verifying the client approved requirements and design.The Clinical Operations Advisor should be able to manage multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial. This is a remote role, open to qualified candidates within the Central or Eastern time zones of the United States. Clinical Operations Advisor must have the ability to travel up to 5% of the time. Required Qualifications<ul> <li>Active Registered Pharmacist license in state of residence</li> <li>2-3+ years prior relevant work experience as a pharmacist in managed care (Pharmacy Benefit Management) environment</li> <li>Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics (Medicare, Medicaid, Exchange, and or Commercial) and industry trends</li> <li>Demonstrated experience with Utilization Management and Formulary Management in managed care environment</li> <li>Proficiency with Microsoft applications - Excel, PowerPoint, Word, Outlook, Access, Teams</li> <li>Demonstrated experience with CVSH internal reporting and analytic tools for client management or industry equivalent</li> <li>Excellent written and verbal communication skills both virtually and in person</li> <li>Ability to analyze large volume of clinical data and organize this data for downstream teams such as configuration and testing teams</li> <li>Attention to detail to ensure data fidelity and data integrity is well understood including the business rules for data transformation</li> <li>Ability to work on multiple projects, prioritize, and resolve complex problems</li> <li>Effectively work independently without daily supervision</li> <li>Impact and influence others</li> <li>Drive results and deliver on goals and commitments</li> <li>Facilitate cross functional communication and collaboration</li> <li>Consult and influence internal stakeholders and client contacts</li> </ul> Preferred Qualifications<ul> <li>Experience supporting Pharmacy Benefit Management (PBM) clients or within a health plan</li> <li>Experience in all market segments (Medicare, Medicaid, Exchange and Commercial)</li> <li>Expertise in Utilization Management, Formulary Management and Clinical Products</li> <li>Experience implementing template and/or customized clinical programs</li> <li>Knowledge of PBM adjudication engine and other systems leveraged in support of clients</li> <li>RxClaim experience</li> <li>Proven leadership skills</li> <li>Commitment to client service and relationship building</li> </ul> EducationBachelor Degree in Pharmacy required, PharmD preferredAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$110,925.00 - $249,600.00This 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: 05/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

39 Jobs in Baxley, GA 31513, USA