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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary<ul> <li>Network implementation manager.</li> <li>Configure custom, domestic, and direct-to-employer networks. </li> <li>Subject matter expert for network files, network IDs, and PPO codes.</li> <li>User Acceptance Testing for new implementations and issue resolution.</li> <li>Performs research for network issues and partners with EDI IT on resolution.</li> <li>Coordinates custom online provider directories.</li> </ul> Required Qualifications<ul> <li>2+ years healthcare industry experience.</li> <li>1+ year network operations or provider relations experience.</li> <li>Proficiency in Microsoft Office Suite (Word, Excel, Outlook, etc.).</li> </ul>Preferred Qualifications<ul> <li>1+ year of implementation management experience</li> <li>1+ year of vendor management experience</li> </ul> Education<ul><li> High School Diploma or GED</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $122,400.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Senior Network Analyst

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.

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 Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. This position may support UM, MPO, Coding, or Behavioral Health appeals. Required Qualifications • Must have active and unrestricted RN licensure in state of residence • 3+ years clinical experience Preferred Qualifications• Appeals Experience • Managed Care Experience • Utilization review experience • Proficiency with computer skills including navigating multiple systems • Exceptional communication skills. • Time efficient, highly organized, and ability to multitask Education • Associate's Degree minimumAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$66,575.00 - $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: 04/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Appeals 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 Summary We are seeking a highly skilled and experienced Security Engineer to join our Secure Collaboration Team. The successful candidate will be responsible for maintaining and enforcing security policies for various collaboration platforms, including SharePoint, OneDrive, Teams, Slack, SFTP, eShare, and related capabilities. This role will play a critical part in ensuring the security and compliance of these platforms while supporting the organization's overall secure sharing strategy.Primary Job Duties &amp; Responsibilities<ul> <li>Develop, implement, and maintain security policies for collaboration platforms, like M365, Teams, Slack, and SFTP, ensuring alignment with corporate security standards and regulatory compliance requirements.</li> <li>Oversee user access controls, identity management, and permission policies for collaboration platforms to ensure the least privilege access model.</li> <li>Conduct regular risk assessments and vulnerability assessments for collaboration platforms and implement necessary risk mitigation controls.</li> <li>Work with internal teams to integrate collaboration platforms into the enterprise security infrastructure, ensuring secure configuration and setup.</li> <li>Educate employees on best practices for secure usage of collaboration platforms, promoting a culture of security awareness within the organization.</li> <li>Work closely with IT, compliance, and business teams to ensure security requirements are met and any security concerns are addressed promptly.</li> <li>Develop and maintain collaboration dashboards and KPI reports in PowerBI to continuously monitor usage and trends of various collaboration platforms.</li> <li>Track and report usage of unsanctioned file sharing tools and cloud storages, support documentation of security incidents, response actions, and lessons learned.</li> <li>Stay up to date with security features and tools available for platforms like M365, Teams, eShare, Slack, and SFTP, and leverage them to enhance platform security.</li> <li>Create and maintain Azure Runbooks using PowerShell scripts, and automation using PowerApps.</li> <li>Continuously drive a simplified, consistent user experience at points of service engagement.</li> </ul>Required Qualifications<ul> <li>5+ years of experience in a security engineering or administration of collaboration platforms such as SharePoint, OneDrive, Teams, Slack, and cloud sharing tools.</li> <li>3+ years of experience with data at rest and data in motion encryption and other data protection techniques in cloud environments.</li> <li>2+ year of experience with automation of apps utilizing PowerApp.</li> <li>2+ year of experience in cloud sharing security configuration of M365 services and Azure.</li> <li>2+ year of experience with PowerBI and Azure Runbooks using Powershell.</li> </ul> Preferred Qualifications<ul> <li>Experience with eShare collaboration platform.</li> <li>Experience with secure file access and transfer protocols (SFTP).</li> <li>Excellent problem-solving skills and ability to work independently and collaboratively in a fast-paced environment.</li> <li>Strong communication skills to articulate security risks, solutions, and best practices to non-technical stakeholders.</li> <li>Demonstrated experience working with a wide range of internal and external stakeholders at all levels on strategic and operational information security programs.</li> <li>Strong analytical skills and the ability to understand and solve complex problems</li> <li>Experience in documenting and implementing procedures and guidelines.</li> <li>Continuous learner well informed on technology trends, tools, methodologies, and models.</li> <li>Ability to manage a high degree of complexity and distill information that provides clear direction.</li> <li>Comfortable operating within areas of ambiguity to iterate and make progress in a consistent manner.</li> <li>Agility to deal with a constantly changing business environments.</li> </ul> Education<ul><li>Bachelor’s degree or equivalent experience (High School Diploma and 4 years relevant experience)</li></ul>BUSINESS OVERVIEWBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunitiesAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$101,970.00 - $203,940.00This 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: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Security Engineer - Secure Collaboration

Are you someone who never rests on their laurels, always strives to go above and beyond, and is committed to keeping your PROMISES? Do you appreciate a company culture that is open, fosters work-life balance, and a dynamic team environment? Then Old Dominion is the home for you. We take pride in being the best in the industry, and from our humble beginnings we know that our People and our Family Spirit are the main ingredient in our secret sauce to success. At Old Dominion we are looking for individuals to join the OD Family that will provide innovative solutions and exceed expectations to keep OD the premier transportation solutions provider.Oversee and document the design and development of Middleware solutions that meet business and project needs using choice tools, providing expertise to, and coordinating efforts with internal and external customers.Primary Responsibilities<ul> <li>Implementation, administration, and configuration of Middleware functionality using the selected software and tools. (e.g., Oracle SOA Middleware, Hazelcast, etc.)</li> <li>Monitoring, troubleshooting, and resolving production support incidents.</li> <li>Troubleshoot performance and availability issues in a highly available environment.</li> <li>Perform research, analysis, design, and implementation of technical solutions to meet current and future user requirements.</li> <li>Provide level 2 and level 3 support in resolving incidents, establishing urgency of the problem, and owning the problem through resolution, keeping the client informed of progress.</li> <li>Project responsibilities in all or some of the following areas: project planning, work plan development, testing plan development and staffing.</li> <li>Provide technical assistance on projects throughout the environment.</li> <li>Assure technical and support documentation is complete and up to date.</li> <li>Provide technical assistance and work direction to aid other employees.</li> <li>Perform capacity planning and optimization for systems and services.</li> <li>Act as liaison between hosting provider and application development team regarding the web tier for setup and support of web sites.</li> <li>Act as senior developer on software development projects with responsibility for overall delivery of software components.</li> <li>Mentor less experienced Middleware Programmer Analysts and assist with questions and issues.</li> </ul>Job QualificationsEducation:<ul><li>Associate degree in Computer Science or related field or equivalent education and work experience</li></ul>Experience:<ul> <li>10+ years of experience in web services, application development and large-scale software implementations</li> <li>8+ years of experience developing web services (SOAP/REST) and Java/J2EE application development preferred</li> <li>5+ years of experience in application development using Java &amp; J2EE</li> <li>Proven experience with the administration and support of a SOA infrastructure.</li> <li>Experience installing, configuring, and supporting middleware tools.</li> <li>Experience with relational database technologies (DB2, SQL).</li> <li>Experience in LINUX and Windows.</li> <li>Strong analytical/troubleshooting skills.</li> <li>Self-motivated team player to take ownership of projects without much supervision.</li> <li>Ability to work within standard and change management processes</li> </ul>Compensation Range:The referenced salary range is based on the Company's good faith belief at the time of posting. Actual compensation may vary based on factors such as geographic location, work experience, market conditions, education/training and skill level. ($139,078-$173,826)Working Days:Shift and hours to be determined.Working Shift:Shift and hours to be determined.Work Days and Shift are estimates and are subject to change, at any given time, based on job scheduling and/or business levels. Any information listed regarding Days and Shifts shall be considered a guideline of expectations for the specific position at the time of posting.Application Window:OngoingCandidates are encouraged to apply as soon as possible. Old Dominion plans to screen candidates, conduct interviews, and proceed with hiring candidates to meet its business needs, which may result in filling the role before the current anticipated application window closes.Join the OD Family Today! As a Full Time member of our Family, you and your family are eligible to receive:<ul> <li>Great Health Benefits including a Zero premium medical plan for employee only coverage</li> <li>Vision &amp; Dental</li> <li>Short Term &amp; Long Term Disability</li> <li>Flex Spending Accounts</li> <li>401k Retirement plan with company match and additional company annual discretionary match opportunity</li> <li>Life Insurance</li> <li>Wellness Program</li> <li>12 Days Paid Time Off</li> <li>9 Paid Holidays including a birthday holiday</li> <li>Training and growth opportunities to build a career</li> <li>We prioritize our OD family of employees</li> <li>Ability to advance through our promote from within philosophy</li> <li>National Career Opportunities Available at our 260+ service centers</li> </ul>Old Dominion Freight Line, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, and/or gender expression, sexual orientation, age, disability, pregnancy, genetic information, military status, Vietnam Era and/or veteran status, or any other characteristic protected by applicable law(s).If you have questions regarding this posting or require assistance with the application process, please <a href="https://www.odfl.com/us/en/contact.html" target="_blank">click here</a> for contact information.

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