field_remote_option

job_industry

field_job_occupational_field_parents_all

job_organization_name

job_upgrade_is_featured

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Overview:Aetna, CVS Health is looking for top talent! The Telesales Representative is directly responsible for building a book of business via acquisition of new members using state-of-art lead generation platform supported by real time analytics. Upon acquisition the Telesales Representative will own the member relationship throughout the year and will be the primary contact for member inquiries, including but not limited to, any questions related to plan benefits, product, and services offerings, as well as resolving any issues with respect to the utilization of the product. The position will be a part of a high performing team with strong emphasis on personal and professional development and career growth. Job Responsibilities:<ul> <li>Acquisition of new members via inbound and outbound calls</li> <li>Assessing customer needs for products and services using insightful, probing questions, and demonstrating superior listening skills</li> <li>Servicing of existing members and inquiries related to utilization of their product, benefits, etc.</li> <li>Cross selling ancillary products as well as any other applicable products to existing members</li> <li>Retention of existing members</li> <li>Maintaining knowledge levels with respect to CMS and states regulations</li> <li>Ability to multitask, and effectively use computer while interacting with prospects and members via phone</li> <li>Ensuring that the relevant information is captured in Customer Relationship Management system (CRM)</li> </ul>Accountabilities:<ul> <li>Meeting sales goals, conversion rates, and cross sell rates for acquisition of new members as outlined in the annual performance plan.</li> <li>Contacting prospective members within the time limit outlined in the annual performance plan.</li> <li>Achieving the member retention rate as outlined in the annual performance plan.</li> <li>Highest levels of member satisfaction as measured by various member surveys and member retention rate.</li> <li>Expert level understanding of products, services, and processes offered by the company.</li> <li>Ability to pass on an annual basis:<ul> <li>American Health Insurance Plans (AHIP)</li> <li>Continued Education (CE’s)</li> <li>Product Certification</li> <li>Required Security and Compliance</li> <li>Client/Carrier Certifications</li> <li>Any required CMS Certifications</li> </ul> </li> </ul>Qualifications:<ul> <li>4-year college degree or 1 to 2 years’ experience of selling multiple Medicare products (i.e., Medicare Advantage, Medicare Supplement)</li> <li>Life &amp; Health insurance license is not required to be employed. It is required to obtain the license within 60 days from the employment start date</li> <li>Active use of computer for carrying out daily job activities</li> <li>Ability to multi-task while talking on the phone</li> <li>Excellent communication and listening skills</li> <li>Self-starter with positive attitude and ability to control emotions when dealing with unhappy customers (i.e. “Customer is always right” attitude)</li> <li>Adaptable to high pressure, achievement-oriented environment</li> <li>Drive to build, manage, and grow a book of business and become successful entrepreneur</li> <li>High level of computer proficiency including, but not limited to, Microsoft Office package</li> <li>Ability to quickly perform basic mathematical operations w/out use of calculator</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$15.00 - $24.23This 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: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Inside Sales Rep-Hourly + Commission-Can live anywhere in U.S.

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 SummaryA Brief OverviewCVS Health is looking for an experienced analytics leader to grow and direct a diverse and talented Data Science team. A&amp;BC is an organization working to solve some of the most challenging problems at the intersection of technology and healthcare. A&amp;BC leverages advanced analytics, machine learning, modeling, and a hypothesis-driven approach to quickly transform data into actionable, customer-centric insights to drive growth, improve health outcomes and access to health care across all of our businesses in CVS Health. What you will do<ul> <li>Lead a team of analytic professionals in driving business value through data science solutions</li> <li>Collaborate with stakeholders across the organization, including executives, clinicians, technology professionals, and business analysts, to understand business strategy and provide data-driven solutions</li> <li>Provide thought leadership and guidance in the development of analytic solutions and business insights for stakeholders</li> <li>Define data science initiatives by utilizing data mining, data modeling, large language models, and machine learning techniques to extract data from multiple sources and deliver predictive models that inform solutions</li> <li>Design and develop data solutions that meet client requirements and organizational quality standards by leveraging industry-leading tools, technologies, and best practices to profile and translate data</li> <li>Apply data science expertise and machine learning knowledge to improve patient care capabilities, optimize healthcare operations, and drive evidence-based decision-making</li> <li>Develop and implement analytical frameworks, key metrics, and performance dashboards to monitor, measure, and evaluate healthcare quality, efficiency, and performance</li> <li>Deliver presentations and consultative services to existing and prospective constituents on data analytics results and solutions</li> <li>Communicate with leaders to introduce and operationalize incremental KPIs that contribute to the company's overall revenue and profitability targets</li> <li>Help establish and implement programs that ensure departmental adherence to all applicable data governance policies and procedures by educating team members on data science best practices</li> <li>Continually evolve and ensure delivery against an analytics roadmap aligned with business partners</li> </ul> Required Qualifications<ul> <li>10 + years total business experience</li> <li>7+ years' experience with statistical concepts and advanced analytic techniques, such machine learning models (e.g., linear regression, tree-based non-linear, time series, random forests, natural language processing (NLP)), generative AI (Gen AI), clustering and segmentation, customer lifetime value, A/B testing, etc. to extract insights from text data</li> <li>5+ years of business experience leading Healthcare analytic projects and initiatives from concept to delivery, coordinating across diverse stakeholder groups with track record of business impact</li> <li>5+ years' experience handling multiple, complex projects in a deadline-driven environment, anticipating and preventing roadblocks throughout a project lifecycle and driving resolution/mitigation</li> <li>5+ years of people management experience, leading highly effective and engaged teams</li> <li>5+ years' experience with analytic and modeling tools and software, such as Python and SQL</li> </ul> Preferred Qualifications<ul> <li>Excellent analytical and problem-solving skills</li> <li>Strong written and verbal communication skills, including the ability to present complex ideas to various audiences</li> <li>Experience with Medical Economics and Trend Analytics</li> <li>Highly self-motivated and attentive to detail</li> <li>Proficiency with Google Cloud Platform (GCP) tools, including BigQuery, Vertex AI, DataProc, and Cloud Composer</li> </ul>Education<ul> <li>Bachelor’s degree or equivalent work experience in Mathematics, Statistics, Computer Science, Business Analytics, Economics, Physics, Engineering, or a related discipline.</li> <li>Master’s degree preferred.</li> </ul>Pay RangeThe typical pay range for this role is:$144,200.00 - $288,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Lead Director, Data Science - Healthcare Analytics

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.CVS Health has an exciting opportunity for an Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will support data analysis, predictive modeling, and evaluation reporting within our Medicaid lines of business. The position will involve extracting, collecting, analyzing, and interpreting health, utilization, and financial data from many sources to address business questions regarding population health management, health and economic outcomes, and other business needs. You will be responsible for maintaining risk score model integrity across multiple states and communicate to business leaders the key drivers of results. Join this exciting opportunity to work directly with different teams across the organization and have a meaningful impact on our business! Successful candidates will possess the following abilities: - Design and code efficiently in SQL, SAS or similar programming language - Execute algorithms to solve business problems- Willing to probe into technical details, and problem solve - Build and improve processes - Juggle multiple priorities - Be organized and exhibit attention to detail Required Qualifications - 5 or more years of data analytics experience - 3 or more years of experience in technical programming fundamentals in SQL, SAS, or other data management software - 3 or more years of experience in creating reports and pivot tables in Excel Preferred Qualifications - Knowledge of government-regulated healthcare programs such as Medicare or Medicaid - Knowledge of health insurance concepts - Experience working in risk adjustment - Experience working at a health plan - Attention to detail and working independently - Project management experience EducationBachelor's Degree or equivalent work experience requiredAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Informatics Manager, Risk Adjustment Analytics

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. Preferred applicants will currently hold 5 or more licenses in a combination of the following states: CA, WA, AZ, FL, NV, PA, TX, NC, MI, WI, OK, ME, MN, MO, IN, TN, CO, IL, NY, MD, OR, LA, DC, UT, NE, KY, KS, SC, OH, VA, GA, NJ - Licensed Clinical Social Worker (LCSW), Licensed (Clinical) Professional Counselor (LPC or LCPC or LPCC) , Licensed Mental Health Counselor (LMHC), or Licensed Marriage and Family Therapist (LMFT) Full Time or Part Time, Fully Remote - Licensed Clinical Therapist Position Summary: Join the MinuteClinic team, an industry-leading company for a refreshing change in a stable, consistent, and professional environment. We empower our therapists to practice at the top of their license with the support of our clinical care team, while reaching patients within their communities. What our Licensed Clinical Therapists find at MinuteClinic: - Autonomy to build and grow the MinuteClinic practice without the burden payor contracting, credentialing, and billing. - Opportunities to provide psychosocial support and education needed to address the mental wellbeing of individuals, couples/families ages 13+. - Evidence-based care and access to assessment and treatment planning tools to elevate and support the continuity of care for patients. - Career growth and professional development within the organization. - In-depth training, development, and support. Required Qualifications - Current, active, and unencumbered Multistate Licensure Licensed Clinical Social Worker (LCSW), Licensed (Clinical) Professional Counselor (LPC or LCPC) LPCC (CA ONLY) , Licensed Mental Health Counselor (LMHC), or Licensed Marriage and Family Therapist (LMFT) - Will be required to obtain licenses to practice in multiple states based on business needs. - Proven excellent diagnostic, care collaboration, treatment planning, and short-term counseling skills leveraging evidence-based methodologies including but not limited to motivational interviewing, problem solving therapy, and cognitive behavioral therapy Preferred Qualifications - Preferred applicants will currently hold 5 or more licenses in a combination of the following states CA, WA, AZ, FL, NV, PA, TX, NC, MI, WI, OK, ME, MN, MO, IN, TN, CO, IL, NY, MD, OR, LA, DC, UT, NE, KY, KS, SC, OH, VA, GA, NJ - Demonstrated exceptional interpersonal and team skills - Experience with or willingness to learn and adapt to virtual therapy delivery - Proven deep understanding of the psychosocial aspects of illness and health - Tech-savvy and comfortable using electronic health record systems and engaging on multiple platforms - Demonstrated understanding of insurance, Medicaid, Medicare billing requirements - Evidence of strong crisis intervention skills - Previous experience in a mental health clinic or hospital setting Education - Completed Master’s degree program from an accredited College or University. - Multistate License Required. Alaska (AK), Arizona (AZ), California (CA), Florida (FL), Idaho (ID), Missouri (MO), Texas (TX), Hawaii (HI), Oregon (OR), Arkansas (AR), New Hampshire (NH), Vermont (VT), Wyoming (WY) and Idaho (ID) Licensed Clinical Social Worker (LCSW), Licensed (Clinical) Professional Counselor (LPC or LCPC) LPCC (CA ONLY) , Licensed Mental Health Counselor (LMHC), or Licensed Marriage and Family Therapist (LMFT) 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. Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$26.01 - $74.78This 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>This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Licensed Clinical Therapist - Multistate

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 SummaryThis position will be on the Aetna Voluntary Underwriting team and is responsible for new business and renewal underwriting for Accident, Hospital Indemnity Protection, and Critical Illness products. The Senior Manager will administer strategy for Underwriting to support the organization’s financial and strategic goals, ensuring underwriting decisions are consistent, effective, and compliant.Key Responsibilities:<ul> <li> Strategic Planning &amp; Administration:<ul> <li>Contribute to the planning and administration of company programs and initiatives that promote the Underwriting area’s agenda.</li> <li>Implement organizational policies, goals, and objectives based on best practices in the field.</li> </ul> </li> <li> Underwriting Methodology:<ul> <li>Develop methodology to underwrite voluntary benefits products within established requirements to ensure profitability and achieve a consistent loss ratio target.</li> <li>Align management of large new and renewal group quotations to underwrite profitable business for the region.</li> </ul> </li> <li> Analysis &amp; Reporting:<ul> <li>Deliver analysis and reporting on underwriting key performance indicators and recommend actions for improvement.</li> <li>Advise on competitor activity, third-party activity, and changes in law that may affect underwriting performance.</li> </ul> </li> <li> Product Development:<ul><li>Participate in the design of new voluntary benefits products, ensuring they meet market needs and profitability targets.</li></ul> </li> <li> Team Management:<ul> <li>Manage operational aspects of the team, including budget, performance, and compliance.</li> <li>Implement workforce and succession plans to meet business needs.</li> </ul> </li> </ul> Required Qualifications<ul> <li>7 to 10 years of experience in underwriting.</li> <li>3 to 5 years experience in underwriting voluntary benefits products, including Accident, Hospital Indemnity Protection, and Critical Illness.</li> <li>Proven track record of developing and implementing underwriting strategies that drive profitability and growth.</li> </ul> Preferred Qualifications<ul> <li>Demonstrated ability to develop and execute long-term strategic plans that align with organizational goals.</li> <li>Experience in driving innovation and implementing new initiatives to enhance underwriting processes and product offerings.</li> <li>Experience in collaborating with sales, marketing, and customer service teams to develop and promote customer-focused underwriting solutions.</li> <li>Strong interpersonal skills and the ability to build and maintain relationships with key stakeholders, including clients, brokers, and consultants.</li> <li>Experience in leveraging technology to streamline underwriting processes and improve efficiency.</li> </ul> Education<ul><li>A bachelor’s degree from an accredited institution is required. Preferred fields of study include business administration, finance, economics, mathematics, or a related discipline. An advanced degree (MBA, Master’s) is a plus.</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: 06/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Underwriting Tech Lead

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 CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs).This is a remote based, work from home opportunity. The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&amp;T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies. Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise’s decisions and planning. – Each Director is responsible for providing oversight of a portion of CVS Health's clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. – Directors will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. – Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage. –In this role you'll perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department. CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director (Medical Affairs). Required Qualifications * Family Medicine or Internal Medicine Board Certification.* Minimum of 5 years clinical experience in direct patient care. * 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs * Unrestricted license to practice medicine in the state in which the candidate is located. Preferred Qualifications * Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e.g., RNs, PharmDs, etc.). * ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine) * Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired * Proficiency in MS Office Suite Education * Must be graduate of an accredited Medical School and Residency Program * Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia * Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employmentPay 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: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Medical Affairs)

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.Job Summary<ul> <li>Develops Network database tools that enable network management to work more efficiently and focus efforts effectively.</li> <li>Advises on provider performance, network adequacy, geographical coverage, and makes necessary network modifications or expansions.</li> <li>Implements improvement initiatives to ensure that network databases meet all applicable regulatory and quality standards.</li> <li>Conducts market analysis, assesses competitive positioning, and recommends strategies to maintain a competitive edge.</li> <li>Consults with internal teams, including medical directors, operations managers, and network development professionals, to align provider network performance goals and objectives.</li> <li>Provides continuous recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.</li> </ul> Required Qualifications<ul> <li>A minimum of 5 years of SQL and QuickBase (developing and building of dashboards), Python, SAS, Access, Excel, Salesforce, and/or other large data management tools.</li> <li>Adept at machine learning and AI</li> <li>Adept at managing large amounts of data</li> <li>Adept at project management</li> <li>Adept at problem solving and decision-making skills</li> <li>Adept at collaboration and teamwork</li> <li>Adept at Growth Mindset with Mentorship Capability</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> <li>Adept at business intelligence (data driven insights)</li> <li>Intrinsically Driven</li> <li>Proactive Initiator</li> </ul> Preferred Qualifications<ul> <li>Prior Relevant Work Experience with a health system or large payor.</li> <li>Adept at Google Cloud/Desktop</li> </ul> Education<ul><li>Bachelor's degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/17/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr. Network Management Manager - QuickBase

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.Job Purpose and Summary:This position is responsible for long range (12-18 months) and midrange (0-26 weeks) business forecasting and staff capacity planning for call and back office operations for Specialty Operation. This individual will be part of a team that owns the business planning, including staffing requirements and metrics performance as well as the many different types of analysis that are needed on an ad-hoc and reoccurring basis.This role is responsible for forecasting, modeling, performance projections, intermediate financial variance explanations, and analysis. This person must be able to clearly articulate a clear and concise narrative regarding weekly and monthly variances to budgets and/or quarterly reforecasts.Building strong working relationships with in a heavily matrixed environment and delivering on individual commitments will be critical to the success of this role. Candidates should possess outstanding analytical and critical-thinking skills as well as a proven track record of collaboration within cross-functional organizations (i.e. operations and finance). This person MUST be curious and want to understand how things work to drive continuous improvements.Primary Job Duties &amp; Responsibilities:Maintain accurate labor forecasts to predict staffing needs under a variety of intake volumes, workloads, work activities, rates and other conditions using data/statistical analysis.Participate/Lead weekly and monthly resource discussions with business partners including Operations, HR, Talent Acquisition, Training, and Vendor Management, to ensure current and future business outlooks are well documented and socialized.Maintain volume and handle time forecasts for all lines of business for all call and pharmacy functions; produce and communicate vendor locked forecasts.Investigate volume and handle time forecast variances and incorporate into upcoming forecasts.Actively participate in peak season staffing planning meetings including coordination of new hire classes and target LOBs.Contribute to quarterly forecast submission data for financial outlooks.Required Qualifications:<ul> <li>3-5 years of experience with Call Center and Backoffice Workforce Management/Resource Planning</li> <li>Specialty Pharmacies</li> <li>Basic finance fundamentals</li> </ul>​Skill In: <ul> <li>Strong Excel a MUST</li> <li>Tableau and/or other BI tools preferred</li> <li>Avaya/CMS, Verint or NICE</li> <li>Having a curiosity to drive change and improvements</li> </ul>​Ability To: <ul><li>Data analysis, problem solving, communicate at upper management level</li></ul>Education: <ul><li>Bachelors Degree in related field or equivalent experience is required</li></ul>Preferred Qualifications: <ul><li>5-8 years of experience in Pharmacy/PBM Operations</li></ul>Skill in:<ul><li>Plan and operations optimization</li></ul>Ability To:<ul> <li>Ability to obtain, review, analyze and compile information from multiple data sources</li> <li>Ability to handle multiple tasks with competing priorities</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Manager, Business Analytics (IC)

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 SummaryPrimary responsibilities include drafting, managing, and overseeing dental Medicaid and Medicare contracts across existing and new markets. This role involves negotiating contracts terms with dental vendors to ensure compliance, financial viability, performance, and alignment to organizational goals. The Senior Manager will also develop and implement standardized processes for contracting, working closely with internal stakeholders and vendor partners to enhance efficiencies, mitigate risks, and support the market performance and expansions efforts. This is an individual contributor role. Required Qualifications<ul> <li>5+ years of Provider Contract Negotiations</li> <li>3+ years’ experience with RFP</li> </ul> Preferred Qualifications: <ul> <li>Dental vendor experience</li> <li>Strong contract negotiation experience</li> <li>3-5 years Dental Medicaid and Medicare experience drafting and negotiating contracts.</li> <li>3-5 years’ experience in vendor partner management</li> <li>Customizing Dental Medicaid and Medicare contracts proposals and Amendments.</li> <li>Ability to meet strict deadlines and manage priorities.</li> <li>Establishing and building strong relationships externally and internally</li> <li>Collaborate with various departments within health plan markets and internal teams.</li> <li>Adaptability when priories shift</li> <li>Advance knowledge of excel, pivot tables, SharePoint.</li> <li>Sound judgement and problem-solving skills</li> <li>Driven individual that can work independently and as a team.</li> </ul>Education Bachelors or equivalent professional work experience.Pay RangeThe typical pay range for this role is:$67,900.00 - $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. 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: 05/16/2025Qualified 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