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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.This position will be working from home anywhere in the US. Standard business hours 8:00am-5:00pm in time zone of residence Monday - Friday. Position SummaryThe Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer. Required Qualifications<ul> <li>3+ years of clinical experience required.</li> <li>Active and unrestricted RN licensure in state of residence.</li> </ul> Preferred Qualifications<ul> <li>Managed Care experience.</li> <li>Utilization Management experience.</li> <li>Appeals experience. </li> <li>Pre Certification experience.</li> <li>Pre Authorization experience .</li> </ul> Education<ul> <li>Associates Degree minimum OR Diploma RN required</li> <li>Bachelors Degree preferred</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,095.00 - $142,576.00This 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: 06/04/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Appeals Nurse Consultant - Fully Remote

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Company: Oak Street Health Title: Sr Analyst,Prod Serv/SupptLocation: RemoteRole Description: As a Sr Analyst, Production Services/Support, your job will be to act as a bridge between the engineering and operations teams during production incidents, Change management, and problem management. You will collaborate with application owners, varying levels of management, and other team members to plan and implement Incident, Problem, and Change management related process improvements, report service management metrics, and serve as a liaison to software vendors and various IT staff for multiple applications and their infrastructure.This role requires on-call availability during evenings, overnight hours, and weekends on a rotating schedule.Core Responsibilities:<ul> <li>Serve as the first responder for major production issues for the Production Management support team.</li> <li>Lead major incident bridges, guiding resolver teams to achieve incident resolution within SLAs.</li> <li>Continuously assess business impact and communicate effectively across various groups and channels, including executive management.</li> <li>Engage necessary resources, including technical, product, and vendor personnel.</li> <li>Provide timely and accurate communication to all affected parties, including executive management.</li> <li>Maintain accurate incident and problem records in ticketing systems (e.g., JIRA, ServiceNow).</li> <li>Document incident timelines and remediation actions.</li> <li>Join forces with problem management in Root Cause Analysis (RCA), corrective actions through closure and proactive problem management.</li> <li>Prepare and present metrics, status and service health reports.</li> <li>Conduct training and knowledge-sharing sessions for various teams and new hires to support standardized processes.</li> <li>Drive the continuous improvement of service management processes and procedures to maintain high service quality.</li> <li>Regularly provide input and status updates for project tracking activities.</li> <li>Maintain the repository of troubleshooting documentation (Run book, Job Aids, Scripts, and Standard Operating procedures)</li> <li>Provide on-call support during non-business hours (team provides 24x7 support for incidents)</li> <li>Write scripts and automate as much of the production support as possible.</li> <li>Other duties as assigned</li> </ul>What are we looking for?<ul> <li>3 years of Production support experience and relevant experience in Service Now, DevOps, TechOps, Monitoring tools, and Process Improvements</li> <li>Preferred ITIL certification</li> <li>Ability to do complex, in-depth analysis and develop innovative methods to accelerate resolution with systems comprising custom developed products, SaaS, and other platforms.</li> <li>Advanced verbal and written communication skills necessary to present/explain technical knowledge, and provide advice to management, regulators, reviewers, and stakeholders.</li> <li>Experience and skills needed for customer support to include a focus on listening, rapport-building, clear communication, friendly and approachable nature, and courtesy and respect.</li> <li>They must possess an operations-oriented mindset and a knack for technical firefighting, diagnostics, troubleshooting and problem solving.</li> <li>Experience with ticketing systems (e.g. ServiceNow, Jira Service Management) is strongly preferred</li> <li>US work authorization.</li> <li>Someone who embodies being "Oaky".</li> </ul> What does being "Oaky" look like?<ul> <li>Radiating positive energy</li> <li>Assuming good intentions</li> <li>Creating an unmatched patient experience</li> <li>Driving clinical excellence</li> <li>Taking ownership and delivering results</li> <li>Being relentlessly determined</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: 06/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Analyst,Prod Serv/Suppt (Major Incident Management)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryManage the development, submission, and state approval process for insurance form filings. Key Responsibilities:<ul><li>Drafting and reviewing product filings:</li></ul>Draft Medicare Supplement and short-term limited duration health insurance products (policies, forms, brochures, etc.) to ensure compliance with all applicable laws, regulations, and guidelines.<ul><li>Compliance:</li></ul>Verify that the products meet specific requirements regarding benefits, premium structures, eligibility, and other relevant aspects.<ul><li>Regulatory Updates:</li></ul>Stay abreast of changes in state and federal regulations related to Medicare supplement insurance.<ul><li>Record Keeping:</li></ul>Maintain accurate records of product filings and related correspondence.<ul><li>Coordination:</li></ul>Collaborate with other business areas and stakeholders within the company throughout the product filing and approval process.<ul><li>Specialized Knowledge:</li></ul>Possess a strong understanding of Medicare supplement and short term, limited duration health insurance products including and their benefits. Required Qualifications<ul> <li>Minimum of five (5) years of work experience in insurance product development and a policy forms drafting capacity with a health insurance carrier.</li> <li>Minimum of five (5) years of work experience with, health insurance products, specifically including Medicare Supplement and short-term limited duration health insurance plans, products, applicable regulations, and industry practices.</li> <li>Familiarity with legal research and review of applicable statutes and regulations.</li> <li>Strong analytical skills with the ability to review and analyze complex data and documents.</li> <li>Experience with independently drafting complex health insurance policy documents, applications, policy riders, and outlines of coverage.</li> <li>Strong attention to detail, in particular accuracy and meticulousness in reviewing and processing filings via SERFF.</li> <li>Excellent ability to communicate effectively, both verbally and in writing to effectively coordinate and communicate with internal business partners and insurance departments.</li> <li>Problem-Solving Skills: Ability to identify and resolve issues related to product filings.</li> <li>Software Proficiency: Proficiency in relevant software and databases such as Microsoft Word, Microsoft Teams, Adobe, PowerPoint, and Workfront. </li> <li>Experience with responding to insurance department questions and objections in response to insurance product filings.</li> <li>Extensive knowledge of insurance department rules and regulations governing coverage forms, endorsements, rules, and policy language requirements.</li> <li>Maintains a high level of confidentiality and professional demeanor and approach in the performance of duties.</li> <li>Must possess initiative to work independently without frequent supervisory involvement.</li> <li>Ability to quickly understand new insurance products and product changes.</li> <li>Possess high organizational skills and ability to set and adjust priorities.</li> <li>Ability to make decisions within scope of authority.</li> </ul>Preferred Qualifications Education High School diplomaAnticipated 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: 05/05/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Analyst, Product & Regulatory Approvals

Liberty Mutual Strategic Ventures

Account Consultant II, Risk Control

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryAetna, a CVS Health company has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy &amp; Operations) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. The Primary Responsibilities of the Medical Director include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will: ◾Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. ◾Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests.◾Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. ◾ Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. ◾Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. ◾Work Collaboratively with the functional areas. Required Qualifications*Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. *M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Preferred Qualifications* Health plan/payor experience. * Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Strong communication skills both written and verbal. Education* M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experiencePay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/14/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Medical Policy & Operations)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Must live in Central or Eastern Time Zone Training Schedule: Mon - Fri 9am-530pm EST Post Training Schedule: Must be available to work 8 hours between 8am-6pm Position Summary Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position 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></ul><ul> <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</li> </ul> Education High School DiplomaAnticipated 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: 05/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Health Concierge

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary This position will be part of the Corporate Affairs team implementing an enterprise-wide program to centralize all executed agreements onto one software platform and may assist with other cross-functional initiatives as needed. This Lead Director role will support the planning, oversight, and coordination of efforts poised to simplify the way we access and use executed contracts. A critical team leader in driving governance, process, reporting, communication and resourcing components of the program, including strong project management disciplines and offering significant exposure to business segment, functional and corporate leaders. This role is for an advocate, change agent and trusted advisor for the business relationship, driving engagement and adoption. It requires a blend of project management, legal contract knowledge, vendor engagement, and technical savvy to lead the implementation of the program. Key goals are to lead the program through key activities related to implementation and adoption, governance and compliance, and data and reporting. Key skills include collaborating cross-functionally to secure required resources and creating and uses formal processes and tools to manage resources, budgets, risks and changes, as well as to assessing roadblocks to ensure on-time completion according to specifications and within budget. The successful candidate will be a thought partner and resilient with dynamic workloads, competing priorities and complex business problems. We are looking for a strategic thinker that brings tactical change with the willingness to encourage trust and collaboration between business, finance, technology and other business partners. The ideal candidate: -Leads and manages projects and programs from initiation to completion, ensuring they are delivered on time, within budget, and according to the defined scope. -Collaborates with senior management to develop strategic plans and objectives for projects. -Identifies project stakeholders, establishes effective communication channels, and manages their expectations. -Develops mitigation strategies to minimize potential negative impacts while regularly monitoring risks and implementing contingency plans when necessary. -Monitors expenditures throughout the project lifecycle and ensures adherence to financial constraints. -Prepares and presents project progress reports to stakeholders and senior management. -Identifies areas for improvement in project and program management processes. -Implements best practices, lessons learned, and industry standards to enhance efficiency and effectiveness. -Provides leadership and guidance to project teams by assigning responsibilities, setting performance expectations, and motivating team members to achieve project objectives. -Encourages an environment that promotes innovation, collaboration, teamwork and ability to think strategically, while also being able to understand detail and execute tactically as needed. -Effectively listens and uses skills such as influencing without authority to help drive conversations with legal and business stakeholders to communicate the business need, program value and vision, and timeline expectations, while ensuring program stays on track. -Proven experience successfully implementing change in complex organizations; builds and maintains strong relationships with technical and non-technical resources and is a champion for our program and processes. -Operates with a keen process/function, data/reporting and project discipline being mindful of audiences and artifacts to convey the most efficient messaging. -Manages multiple competing priorities and delivers on tight timelines, while ensuring all engaged teams are also delivering on time. -Identifies improvement and implements new practices that will effectively influence this enterprise-wide program with our end users, exhibiting CVS Heart at Work Values. -Works closely with vendor staff to help remove barriers and obstacles, allowing our internal stakeholders to be successful using our solution. -Has strong problem-solving and critical thinking skills; learns quickly and is self-motivated. This job might be for you if: You're energized by being part of a cross functional team working in a fast-paced environment. You enjoy working in teams with a diverse set of experiences and backgrounds. You listen to others’ ideas with an open mind. You’re a leader. And you know this means more than leading people. You know that it means taking initiative with a project - anticipating the next steps and taking action before asked. You also know that it can mean leading from behind and stepping in with much needed support. You enjoy solving complex problems. If you don’t know how to do something, you work to find the answers. You don’t get frustrated easily when something doesn’t go the way you planned. You can take complicated concepts and communicate them effectively to a variety of audiences. You write well. You pay attention to the details. You can articulate your thoughts eloquently. You are self-motivated. You take ownership of your work and your team’s work. You pay attention to the details. You “think big” and encourage others to take calculated risks in exploring unconventional ideas and challenging the status quo. In order to be successful in this role you must exhibit the following: A proven track record of success working across multiple business areas including operations, finance, product, technology and strategy. Experience supporting contracting life cycle and working directly with internal legal and business clients. Ability to remain effective in virtual and physical working environments. Excellent social, written, and verbal skills, including with company leaders Proven high levels of initiative, innovation, and collaboration; effectively works across diverse teams. Demonstrated ability to navigate through ambiguity and provide a structured problem-solving approach. Positive attitude and demonstrated flexibility in re-prioritizing and executing program milestones. Adept at execution and delivery (planning, delivering, and supporting) skills. Adept at business intelligence. Adept at collaboration and teamwork. Mastery of problem solving and decision making skills. Mastery of growth mindset (agility and developing yourself and others) skills. Required Qualifications10+ years of professional experience as a key contributor or leader of large-scale initiatives.7+ years of experience driving long-term, highly complex, high-value programs or projects.5+ years of experience in a large matrix organization.3+ years of experience in developing high-impact presentations for senior-level leaders. Preferred QualificationsMasters in Business Administration degree preferred.Proficient with MS Office: Outlook, Teams, Excel, PowerPoint, Word, Project and other collaboration tools.Proficient with Quick base and SharePoint.Paralegal and/or Project Manager certifications, preferred. EducationBachelors degree required or equivalent years of relative experience.Pay RangeThe typical pay range for this role is:$100,000.00 - $231,540.00 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.

Lead Director, Corporate Affairs Project Management

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary The Customer Service Supervisor (Meritain Health) typically:<ul> <li>Develops, motivates, evaluates, and coaches staff on work procedures, proper call handling, and teamwork to deliver excellent customer service.</li> <li>Maintains a visible presence and is available to staff to answer questions, monitor calls, and give ongoing feedback.</li> <li>Utilizes available incentive programs to reward, recognize, and celebrate team and individual successes.</li> <li>Assesses individual and team performance on a regular basis, and provides candid and timely feedback regarding developmental training needs; includes completion of monthly and annual scorecards.</li> <li>Monitors all performance metrics, such as daily stats and schedule adherence; allocates resources to meet volume and performance demands.</li> <li>Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.</li> <li>Removes barriers to job performance and ensures regulatory compliance.</li> <li>Attracts, selects, and retains high caliber, diverse talent, able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.</li> <li>Acts as liaison between staff and other areas, including management, communicating workflow results, ideas, and solutions.</li> <li>Proactively analyzes constituent data, identifying trends and issues. Recognizes and acts on the needs to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.</li> <li>Effectively applies and enforces Aetna HR (Human Resources) policies and practices, i.e., FML (Family Medical Leave)/EML (Extended Medical Leave), Attendance, Code of Conduct, Disciplinary Guidelines, etc.</li> <li>All other duties as deemed necessary to the job function.</li> </ul>Required Qualifications<ul> <li>2 years of experience supporting a claim and/or customer service team in a production-based environment.</li> <li>Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).</li> <li>Ability to work five 8-hour shifts from Monday-Friday between 8am-7:30pm EST. </li> </ul>Preferred Qualifications<ul> <li>Acutely organized and able to effectively prioritize daily workload.</li> <li>Previous experience in the healthcare industry.</li> <li>Previous experience with self-funded or fully insured health care, sales, account management, or TPA (Third-Party Administrator) experience. </li> </ul>Education High school diploma or GED.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $102,081.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Customer Service Supervisor (Meritain Health)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.As a Senior Product Manager at CVS Health, in our "Analytics &amp; Behavior Change" group, you will be on the front line of driving innovation and directly impacting business decisions. This role is part of a team that works across the Pharmacy Benefits Management ecosystem building analytical cloud-based products, supporting pharmaceutical forecasting and pricing. You will have a chance to modernize legacy systems using cutting edge technology, to bring in accuracy and efficiency by using data science and AI. You will work with teammates from our business groups, data science, data engineering, and application development, as well as with your peers from partner product owners. you will be developing components of a software product that serves financial users from our Pharmacy Benefit Manager (PBM) business unit. You will work on multiple components of Data and Forecast Mart (DFM) and Computation Engine (CE) application, where data resides on GCP thru multiple sources and egressed to Azure for forecasting and modeling. The products we are building have a strong forecasting, what-if scenario, and financial component to them.What is your role:<ul> <li>Leading a team responsible for digital product development by defining strategy, vision, product roadmaps, prioritizing feature development, collaborating with stakeholders, and ensuring successful product launches.</li> <li>Overseeing the entire product lifecycle, including user research and interview, requirements gathering from various stakeholders/SMEs, end to end architecture/design, development, testing, integration, and iteration.</li> <li>Working across the organization to align product strategies with business goals, manage stakeholders, and facilitate effective collaboration between product teams and other departments to drive product success and customer satisfaction.</li> </ul>What you will be doing:<ul> <li>Identifying new opportunities, assessing the company’s product performance, and helping develop its long-term strategic plans for future product lines.</li> <li>Establishing the efficient user research, requirement management, prioritization, and delivery of the digital product roadmap to successfully enhance the company's brand recognition and competitive advantage in the industry.</li> <li>Developing technology and product roadmaps to provide visibility of risk and improvement options to maintain a proactive attitude among the digital product team.</li> <li>Analyzing qualitative and quantitative data to influence product features and prioritization to successfully deliver value to the users and company.</li> <li>Facilitating continuous and cross-communication across functional units and stakeholder groups, establishing relationships with collaborators at every organizational level.</li> <li>Defining strategy for product iterations, schedules, releases, and roadmaps to maintain speed to market and differentiation.</li> <li>Discovering, designing, and documenting business requirements and make sure that data scientists, data engineers, QA Engineers, BI engineers, and application developers have enough information to deliver high-value software code.</li> <li>Working with users, business product owners (BPO), release managers and other stakeholders towards requirements and prioritizing features along with synchronizing the release plans across multiple products.</li> <li>Organizing/leading meetings for collaboration and process implementations, status reporting and presentations, supporting resource and budget management.</li> </ul>Required Qualifications :<ul> <li>10+ years of work experience in Software Development projects.</li> <li>5+ years of Product Management experience.</li> <li>5+ years of Agile development methodology.</li> <li> 4+ years' experience working cross-functionally with Engineering or Data Science teams and familiarity with Data Science concepts.</li> <li>1+ year of hands-on experience with any programming language.</li> <li> Proven track record of managing all aspects of a successful analytics product throughout its lifecycle </li> <li>Exceptional communication skills to ensure all stakeholders understand and are aligned with the product plan.</li> <li>Adept at collaboration and teamwork</li> <li>Mastery of problem solving and decision-making skills</li> <li>Ability to thrive in a highly collaborative, fast-paced environment where the nature of the work can be varied</li> </ul>Preferred Qualifications :<ul> <li>History of providing data-based experiences to customers that make the complex understandable.</li> <li> Deep knowledge of various types of Healthcare data, including strong grasp of data nuances, common use cases, and limitations, with experience in common analytics tools </li> <li>experience with forecasting, what-if scenario planning, and financial analysis.</li> <li>Technical hands-on experience with SQL, Cloud based Architecture, PySpark, Python.</li> <li>Any data analytics experience is big plus.</li> </ul>Education :<ul><li>Bachelors degree required</li></ul>Pay RangeThe typical pay range for this role is:$106,605.00 - $284,280.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Analytics Product Manager - Remote

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position 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.

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