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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 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.

CVSHealth

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 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.

Pharmacist - Clinical Operations Advisor

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.Effectively manages competitive and complex contractual relationships with TPAs and/or business partners in Europe, APAC, Africa and Middle East excluding Americas region in support of international network, medical cost management and overall claim/customer service strategies. Provide concierge level of service to our members via timely provision of required network access and proactive management of network relationships to ensure seamless direct settlement access. Job Responsibilities:<ul> <li>Manage TPA relationship with external vendors and own overall relationship with assigned TPAs in Europe, Africa, Middle East and APAC region.</li> <li>Oversee and manage contractual relationship with assigned TPA(s).</li> <li>Manage Third Party Risk Governance process for your assigned TPA(s).</li> <li>Manage ongoing Aetna compliance review process for your assigned TPA(s).</li> <li>Manage monthly billing / submission of TPA invoices for timely payment</li> <li>Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems.</li> <li>Ensure TPA guides, country guides and other internal materials are timely updated and up to date.</li> <li>Ensuring streamline member experience at each country level. Evaluate network options, network efficacies and optimize network utilization to increase direct billing.</li> <li>End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions.</li> <li>Effectively negotiates and manages complex, competitive contractual relationships with providers/vendors according to prescribed guidelines in support of global and regional network strategies. Expand International provider network by contracting new direct pay providers and manage overall contracting process.</li> <li>Act as a Subject matter expert to assist internal sales, account management and sales support team on network and TPA questions / inquiries. Support sales as a subject matter expert on external broker / client calls.</li> <li>Oversee and manage any operational issues and queries regarding your assigned TPA(s).</li> <li>Manage day to day provider operations, either direct or through network business partners. Ensures operational efficiency for all network processes and infrastructure through proactive provider education and collaboration with Aetna International Service Operations</li> <li>Executes regional-specific strategies and tactics in response to market expectations</li> <li>Executes client-specific strategies and tactics for key expatriate clients.</li> <li>Responsible for understanding and managing medical cost issues and initiating appropriate action from the provider perspective</li> <li>Key contributor to enhanced provider service solution like provider portal and other digital solution, including development and/or management of process and technical support.</li> <li>Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas</li> </ul>Required Qualifications:<ul> <li>Benefits Management/Interacting with Medical Professionals</li> <li>Strong project management skills</li> <li>Prior client facing experience.</li> <li>Managing vendor relationships</li> <li>General Business/Demonstrating Business and Industry Acumen</li> <li>Sales/Managing Competitive Networks</li> </ul>Preferred Qualification:<ul> <li>Leadership/Fostering a Global Perspective</li> <li>Health Insurance understanding / business negotiations</li> <li>Service/Demonstrating Service Discipline</li> </ul>Education<ul><li>Bachelors degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/21/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Network Vendor Manager

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.Requisition Job DescriptionPosition SummaryLeads the work and deliverables of multiple marketing campaigns for Aetna Voluntary plan sponsors. Supports initial enrollment and ongoingenrollment communication needs, as well as works on special projects throughout the year. Works cross-functionally with sales,implementation and account management constituents, and externally with human resources and consultants.What you will do<ul> <li>Acts as a top-level specialist on project and program planning and develops comprehensive program plans that encompass objectives, deliverables, timelines, and resource allocation.</li> <li>Adapts project and program plans to ensure alignment with business objectives and reinforce organizational standards.</li> <li>Applies highly developed knowledge of financial management principles to manage cost estimation, tracking, and budget reporting for programs and projects.</li> <li>Coaches’ junior-level project and program managers on how to utilize key performance indicators (KPIs) to measure progress and analyze project and program outcomes.</li> <li>Coordinates knowledge sharing among project teams to highlight success stories and improve project and program management practices through insights.</li> <li>Creates a continuous improvement plan for the project and program department to enhance delivery processes and outcomes.</li> <li>Designs the change management protocol to effectively respond to obstacles that may arise during project and program lifecycles.</li> <li>Utilizes data visualization tools and techniques to present project and program data in a visually appealing easily understandable format.</li> <li>Participates in project/program team training and development activities to enhance project management skills and knowledge.</li> </ul>Required Qualifications<ul> <li>5 + years marketing experience</li> <li>3 to 5 years project management experience</li> <li>Proven communication skills, including writing, presentation, and negotiation skills.</li> <li>Proven track record in meeting project milestones.</li> </ul>Preferred Qualifications<ul> <li>8-10 years of experience related to marketing communications, enrollment technology, customer service and processes, including project consultation preferred.</li> <li>3 to 5 years healthcare experience</li> <li>Expert proficiency with Microsoft Office, inDesign and other marketing software.</li> </ul>Education<ul><li>Bachelor's degree or equivalent professional work experience.</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.

Senior Marketing Manager Project Program Management (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 Summary<ul> <li>Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. </li> <li>Acts as a subject matter expert by providing training, coaching, or responding to complex issues. </li> <li>May handle customer service inquiries and problems.</li> </ul>Additional Responsibilities <ul> <li>Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. </li> <li>Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.</li> <li>Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.</li> <li>Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.</li> <li>Identifies and reports possible claim overpayments, underpayments and any other irregularities.</li> <li>Performs claim rework calculations.</li> <li>Distributes work assignment daily to junior staff.</li> <li>Trains and mentors claim benefit specialists.</li> <li>Makes outbound calls to obtain required information for claim or reconsideration.</li> </ul>Required Qualifications<ul> <li>2+ years medical claim processing experience.</li> <li>Experience in a production environment.</li> <li>Demonstrated ability to handle multiple assignments competently, accurately and efficiently.</li> </ul> Preferred Qualifications<ul> <li>Self funded medical claim processing experience.</li> <li>DG system knowledge.</li> </ul>Education<ul> <li>High School Diploma or GED required.</li> <li>Preferred Associates degree or equivalent work experience.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $42.35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Claim Benefit Specialist

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryCVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Key Responsibilities of the UM Nurse Consultant (Includes but is not limited to)<ul> <li>Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member.</li> <li>Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.</li> <li>Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.</li> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.</li> <li>Communicates with providers and other parties to facilitate care/treatment.</li> <li>Identifies members for referral opportunities to integrate with other products, services and/or programs.</li> <li>Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.</li> </ul>Required Qualifications<ul> <li>Registered Nurse (RN) with current unrestricted US licensure required.</li> <li>2+ years clinical practice experience as an RN required.</li> <li>2+ Years Utilization Management experience.</li> <li>Must be willing to travel to the local office as needed if living within approximately 45 minutes/miles.</li> </ul>Preferred Qualifications<ul> <li>Bilingual proficiency in Arabic, Korean, or Spanish preferred.</li> <li>1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications.</li> </ul>Education<ul> <li>Associate’s degree in Nursing.</li> <li>BSN preferred.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This 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: 06/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryBring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryHealth Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.<ul> <li>Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.</li> <li>Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.</li> <li>Fully understands the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.</li> <li>Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.</li> <li>Uses customer service threshold framework to make financial decisions to resolve member issues.</li> <li>Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).</li> <li>Utilizes all relevant information to effectively influence member engagement.</li> <li>Takes immediate action when confronted with a problem or made aware of a situation.</li> <li>Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.</li> <li>Identifies member needs beyond the initial inquiry by answering the unasked questions.</li> <li>Resolves issues without or with limited management intervention.</li> <li>Provides education to members to support them in managing their health.</li> <li>Responds quickly to meet customer needs and resolve problems while avoiding over-committing.</li> <li>Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.</li> <li>Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.</li> <li>Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.</li> <li>Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.</li> <li>Partners with other departments to deliver client specific presentations.</li> <li>Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.</li> <li>Works collaboratively with colleagues to deliver the best customer experience Seeks to understand the customer, including circumstances, problems, expectations and needs.</li> <li>Asks probing questions to identify the underlying customer needs.</li> <li>Appropriately transitions conversations to explore possibilities for extending customer interactions.</li> <li>Guides members to the appropriate health resource Offers alternatives where appropriate.</li> <li>Acts with the best interest of customer in mind and central to all interactions.</li> <li>Collaborates with colleagues and co-workers to deliver a world class customer experience.</li> <li>Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.</li> <li>May participate in preparation and presentation of client specific presentations.</li> <li>May track and trend data.</li> <li>Coaches, trains and assists in the development of call center staff, as required.</li> <li>Participates in and/or leads special projects/initiatives addressing service issues, as necessary.</li> <li>Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.</li> <li>Delivers internal quality reviews.</li> <li>Provides appropriate support in third party audits when required.</li> <li>Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.</li> </ul> Required Qualifications<ul> <li>Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.</li> <li>Effective organizational skills and ability to manage multiple tasks.</li> <li>Effective communication skills, both verbal and written</li> <li>Experience working with computers Education High School Diploma </li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $25.65This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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