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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<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.

CVSHealth

Senior Network Analyst

Your work days are brighter here.At Workday, it all began with a conversation over breakfast. When our founders met at a sunny California diner, they came up with an idea to revolutionize the enterprise software market. And when we began to rise, one thing that really set us apart was our culture. A culture which was driven by our value of putting our people first. And ever since, the happiness, development, and contribution of every Workmate is central to who we are. Our Workmates believe a healthy employee-centric, collaborative culture is the essential mix of ingredients for success in business. That’s why we look after our people, communities and the planet while still being profitable. Feel encouraged to shine, however that manifests: you don’t need to hide who you are. You can feel the energy and the passion, it's what makes us unique. Inspired to make a brighter work day for all and transform with us to the next stage of our growth journey? Bring your brightest version of you and have a brighter work day here.At Workday, we value our candidates’ privacy and data security. Workday will never ask candidates to apply to jobs through websites that are not Workday Careers. Please be aware of sites that may ask for you to input your data in connection with a job posting that appears to be from Workday but is not.In addition, Workday will never ask candidates to pay a recruiting fee, or pay for consulting or coaching services, in order to apply for a job at Workday.About the TeamAs a member of our diverse and skilled North America Solution Consulting team, you will have the opportunity to communicate and demonstrate the power of Workday's applications to prospects and customers alike. It is this team's job to bring the value of Workday solutions to life and showcase how the world of work can be transformed. Along with working closely with our sales counterparts, this team also sits at the exciting intersection of our Product Management, Consulting Services, Marketing, and Value Management teams, providing exposure to various areas of the business.About the RoleThis is your chance to guide a world class Solution Consulting Team focused on Financials and responsible for selling to prospects and customers in State and Local government. You will be aided and surrounded by some of the first-rate and brightest people in the industry; people who care about our customers and care about assisting them accomplish the results they seek. You will oversee the performance and delivery in support to the sales organization within the region while contributing to the growth of the region and department. Open to traveling 30%About YouBasic Qualifications:<ul><li> Manager, Solution Consultant <ul> <li>5+ years in a sales-related role (sales, presales, value management, customer success, etc.) selling enterprise software</li> <li>2+ years of experience leading people and/or mentoring colleagues on sales opportunity strategy</li> <li>3+ years of working in or selling to Human Resources organizations or have practical HCM experience like Workforce Management, Benefit, comp etc.</li> </ul> Sr. Manager, Solution Consultant <ul> <li>7+ years in a sales-related role (sales, presales, value management, customer success, etc.) selling enterprise software</li> <li>4+ years of experience leading people and/or mentoring colleagues on sales opportunity strategy</li> <li>5+ years of working in or selling to Human Resources organizations or have practical HCM experience like Workforce Management, Benefit, comp etc.</li> </ul> </li></ul>Other Qualifications:<ul> <li>Excellent verbal and written communication skills</li> <li>Experience in a fast-paced work environment</li> <li>Strong problem-solving and critical thinking skills</li> <li>A track record of hiring and retaining innovative employees</li> <li>Consistent achievement or overachievement of assigned goals and targets</li> <li>Success in mentoring coworkers in ways that allowed them to learn new skills and achieve career goals</li> <li>Collaborative with those in other roles to work towards shared goals</li> <li>A history of using data to support your decision-making process</li> </ul> Workday Pay Transparency StatementThe annualized base salary ranges for the primary location and any additional locations are listed below. Workday pay ranges vary based on work location. As a part of the total compensation package, this role may be eligible for the Workday Bonus Plan or a role-specific commission/bonus, as well as annual refresh stock grants. Recruiters can share more detail during the hiring process. Each candidate’s compensation offer will be based on multiple factors including, but not limited to, geography, experience, skills, job duties, and business need, among other things. For more information regarding Workday’s comprehensive benefits, please <a href="https://workdaybenefits.com/us/welcome-to-workday-benefits/prospective-workmates" target="_blank">click here</a>.Primary Location: USA.VA.McLean (Tyson's Corner) Primary Location Base Pay Range: $142,800 USD - $214,200 USD Additional US Location(s) Base Pay Range: $142,800 USD - $214,200 USDIf performed in Colorado, the pay range for this job is $ - $ USD based on min and max pay range for that role if performed in CO.The application deadline for this role is the same as the posting end date stated as below: 06/09/2025 Our Approach to Flexible Work With Flex Work, we’re combining the best of both worlds: in-person time and remote. Our approach enables our teams to deepen connections, maintain a strong community, and do their best work. We know that flexibility can take shape in many ways, so rather than a number of required days in-office each week, we simply spend at least half (50%) of our time each quarter in the office or in the field with our customers, prospects, and partners (depending on role). This means you'll have the freedom to create a flexible schedule that caters to your business, team, and personal needs, while being intentional to make the most of time spent together. Those in our remote "home office" roles also have the opportunity to come together in our offices for important moments that matter.Pursuant to applicable Fair Chance law, Workday will consider for employment qualified applicants with arrest and conviction records.Workday is an Equal Opportunity Employer including individuals with disabilities and protected veterans.Are you being referred to one of our roles? If so, ask your connection at Workday about our Employee Referral process!

Workday

Manager, Solution Consultant - Workday Financials - State and Local Government

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

CompanyCox Automotive - USAJob Family GroupSalesJob ProfileClient Solu Spec II - Express - CAIManagement LevelIndividual Contributor Flexible Work Option Can work remotely but need to live in the specified city, state, or regionTravel %NoWork ShiftDayCompensationCompensation includes a base salary of $49,400.00 - $74,200.00. The salary rate may vary within the anticipated range based on factors such as the ultimate location of the position and the selected candidate's experience. In addition to the salary range identified herein, this role is also eligible for an annual incentive/commission target of $15,000.00.Job DescriptionA Client Solutions Specialist II functions as a member of the Manheim Express team for a designated geographical territory. Primary responsibilities of the role include providing accurate and complete documentation of overall vehicle condition within the parameters of a Manheim Express Inspection and driving incremental business growth within their assigned territory. They will collaborate with the field sales team, auction team members, and other Cox Automotive business units to create and execute a growth strategy.In addition to providing quality vehicle inspections, this client-facing role will take a consultative approach in educating franchise and independent automotive dealers about the Manheim Marketplace, as well as advising them in the utilization of digital wholesale solutions, including Manheim Express and OVE. The Client Solutions Specialist II will provide additional value to our clients by providing outstanding personalized customer service and exceeding the client’s expectations. PRIMARY DUTIES/KEY RESPONSIBILITES<ul> <li>Locate, start, move, and inspect vehicles on dealers’ lots safely.</li> <li>Conduct thorough assessment of vehicle condition following the Manheim Express Inspection process.</li> <li>Verify vehicle identification and enter accurate vehicle information into the inspection system (ie. VIN, mileage, and sub series)</li> <li>Inspect and record vehicle equipment and options, including damage and missing or inoperable items.</li> <li>Inspect and record vehicle exterior condition, including tires, frame, glass, panels, and mechanical components.</li> <li>Inspect and record vehicle interior condition, including seats, dashboard, infotainment system, and options.</li> <li>Perform basic mechanical inspections on vehicles including powertrain, drivetrain, structural, and electrical components.</li> <li>Functions as a team player and work closely with other team members, sales and auction partners, and our client care staff to create a superior client experience.</li> <li>Utilize Salesforce for planning, tracking, and reporting. </li> <li>Inform, educate, and advise dealers regarding policies, procedures, and marketplace strategies.</li> <li>Develop and strengthen relationships with dealers over the phone, online, and in-person.</li> <li>Reviews customers’ performance and recommends solutions for improving conversion rate and/or market share.</li> <li>Partners with sales team in educating and training dealers on Manheim Express products and services.</li> <li>Identifies opportunities for growth and presents Manheim Express as a solution for new and existing clients</li> <li>Demonstrates professionalism and sincere appreciation for client relationships.</li> <li>Strive to consistently improve the client experience by providing high levels of customer service. </li> <li>Generates leads to other Cox Automotive business units.</li> <li>Visibly demonstrates safety commitment by following all safety and health procedures and modeling the behaviors related to such. Actively participate in support of all safety activities aligned with Safety Excellence.</li> <li>Performs other duties as assigned by management.</li> </ul>REQUIRED EXPERIENCE &amp; SPECIALIZED KNOWLEDGE AND SKILLS<ul> <li>BA/BS degree and 2 years work related experience; or an equivalent combination of education and work-related experience.</li> <li>Automotive knowledge preferred.</li> <li>3+ years Auction experience or dealership experience preferred.</li> <li>Valid driver’s license and safe driving record required.</li> <li>Reliable transportation is required. Mileage reimbursed.</li> <li>Effective communication (written and verbal) and interpersonal skills required.</li> <li>Strong technical aptitude.</li> <li>Must be detail orientated.</li> <li>Experience in navigating handheld and other documentation devices preferred.</li> <li>Motivated to work independently with remote supervision.</li> <li>Ability to multitask, follow directions and take instruction is required.</li> <li>Body, paint, and mechanical repair knowledge helpful. </li> <li>Familiarity with unibody and full-frame helpful.</li> <li>Ability to lift and hold at least 30 lbs. at waist level for an extended period of time.</li> <li>Regularly required to stand, walk, talk, and hear.</li> <li>Frequently required to crouch, bend, and kneel to look at side or underneath car. Strength to lift hood or trunk. Bend while performing audits. Reach inside or underneath vehicle. </li> <li>Near vision abilities required to find dings and scratches, paint work, hail damage, frame/unibody, other exterior damage and Interior damage. Able to identify exterior or interior colors.</li> <li>Ability to deal with different lighting (i.e. exterior and interior lighting, natural and artificial light)</li> <li>Exposure to moderate noise level, may be exposed to fumes and odors.</li> <li>Requires physical ability and mental acuity to execute the duties of the position successfully within required timeframes to meet business requirements.</li> <li>Ability to engage customers in a consultative manner.</li> <li>Solid computer skills, including ability to use Internet and MS Office effectively.</li> <li>Ability to adapt to and work effectively within a constantly changing environment.</li> <li>Excellent customer service and problem-solving skills required.</li> <li>Ability to perform repetitive tasks; manual dexterity.</li> </ul>Drug TestingTo be employed in this role, you’ll need to clear a pre-employment drug test. Cox Automotive does not currently administer a pre-employment drug test for marijuana for this position. However, we are a drug-free workplace, so the possession, use or being under the influence of drugs illegal under federal or state law during work hours, on company property and/or in company vehicles is prohibited.BenefitsThe Company offers eligible employees the flexibility to take as much vacation with pay as they deem consistent with their duties, the company’s needs, and its obligations; seven paid holidays throughout the calendar year; and up to 160 hours of paid wellness annually for their own wellness or that of family members. Employees are also eligible for additional paid time off in the form of bereavement leave, time off to vote, jury duty leave, volunteer time off, military leave, and parental leave. About Us Through groundbreaking technology and a commitment to stellar experiences for drivers and dealers alike, Cox Automotive employees are transforming the way the world buys, owns, sells – or simply uses – cars. Cox Automotive employees get to work on iconic consumer brands like Autotrader and Kelley Blue Book and industry-leading dealer-facing companies like vAuto and Manheim, all while enjoying the people-centered atmosphere that is central to our life at Cox. Benefits of working at Cox may include health care insurance (medical, dental, vision), retirement planning (401(k)), and paid days off (sick leave, parental leave, flexible vacation/wellness days, and/or PTO). For more details on what benefits you may be offered, visit our benefits page. Cox is an Equal Employment Opportunity employer – All qualified applicants/employees will receive consideration for employment without regard to that individual’s age, race, color, religion or creed, national origin or ancestry, sex (including pregnancy), sexual orientation, gender, gender identity, physical or mental disability, veteran status, genetic information, ethnicity, citizenship, or any other characteristic protected by law. Cox provides reasonable accommodations when requested by a qualified applicant or employee with disability, unless such accommodations would cause an undue hardship.Applicants must currently be authorized to work in the United States for any employer without current or future sponsorship. <h3> </h3>

Cox Communications

Client Solutions Specialist II (Manheim Express, Seattle, WA)

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 International is looking for a motivated, energetic, team player to join the Large Group Account Management team. This individual will have overall responsibility of supporting a book of business that represents some of Aetna International's largest customers. This position will work remotely and can be in any time zone. They will need to foster strong relationships with customers and producers and they will play a key role in supporting the continued growth of Aetna International's brand in the marketplace.As an Associate Account Manager, the candidate will:<ul> <li>Provides proactive account service management in support of business objectives and to achieve customer satisfaction. </li> <li>Develops and executes customer service strategy. </li> <li>Meets with customers frequently via phone and video conferencing, leads calls, facilitates meetings, and meets customers in person on occasion. </li> <li>Engages in frequent email correspondence, discusses service levels and expectations, shared process improvements, discusses operation of benefit plans. </li> <li>Identifies gaps in service, determines root cause and develops an actionable solution. </li> <li>Engages with other Aetna departments in issue resolution and maintains a service log. </li> <li>The candidate will support client needs in multiple times zones. </li> <li>Responds to customers' requests for network analysis, benefit plan design changes, benefit questions, billing issues, member eligibility and claims. </li> <li>Collaborates with the Account Executive and the sales team to achieve growth/renewal activities including installation, plan set up, eligibility, billing and contract drafting by working proactively with support areas, signs off on ID Cards, Manages member communications strategies for each customer.</li> </ul> Required Qualifications<ul> <li>2+ years of industry or customer service experience preferably with complex accounts.</li> <li>An active resident insurance producer license, as required by state law or obtain an insurance producer license within 60 days of start date.</li> <li>Insurance industry experience</li> </ul> Preferred Qualifications<ul><li>Background in international health insurance</li></ul> Education<ul><li>Bachelor's Degree or equivalent work experience (HS diploma + 4 years relevant experience).</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $76,500.00This 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.

Associate Account Manager (Aetna International)

Cox Automotive Inc.

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.

183 Jobs in Harrisburg, PA, USA