field_remote_option

job_industry

field_job_occupational_field_parents_all

job_organization_name

job_upgrade_is_featured

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Medical Director - SIU (Special Investigations Unit) CVS Health - Special Investigations Unit (SIU) Join our mission to safeguard healthcare integrity and protect patient well-being. As the Medical Director of Healthcare Fraud Investigations, you'll lead our efforts to detect, prevent, and combat fraudulent activities in the healthcare system. **This is a remote based, work from home role.** Key Responsibilities: The Special Investigations Unit (SIU) Medical Director will be responsible for performing reviews of medical records in support of healthcare fraud investigations. Serving as a clinical liaison supporting SIU activities across all lines of business the SIU Medical Director will be responsible for making both pre and post-payment claim payment determinations based on Aetna Clinical Policy and/or state and federal regulations. Additional responsibilities include: <ul><li>Serves as a clinical liaison supporting SIU Investigators, Managers, and Directors in matters pertaining to the investigation of suspected healthcare fraud cases </li></ul> <ul><li>Develops and delivers presentations to internal and external customers regarding healthcare fraud matters and Aetna’s approach to fighting fraud. </li></ul> <ul><li>Provides clinical expertise and business direction in the creation of analytical solutions designed to identify potentially fraudulent scenarios </li></ul> <ul><li>Maintains open communication with constituents within and external to the organization </li></ul> <ul><li>Uses available resources and technology in developing evidence, supporting allegations of fraud, waste, or abuse </li></ul> <ul><li>Documents all appropriate information related to medical review determinations </li></ul> <ul><li>Proactively builds relationships with other internal MDs to obtain clinical guidance when required to ensure accurate decision making </li></ul> <ul><li>Represents Aetna as a witness in legal matters as required, and as approved by the Legal Department. Demonstrates high level of knowledge and acts confidently when providing testimony during civil or criminal proceedings. </li></ul> <ul><li>Responsible for peer to peer reviews of SIU related claims based on provider escalation or state/federal requirements </li></ul> <ul><li>Supports legal efforts by providing expert medical testimony and </li></ul> <ul><li>Conducts root cause analysis to identify potential control gaps in the organization’s existing clinical policy, procedures, claim editing etc., and proactively seeks out appropriate contacts to help implement solutions. </li></ul> <ul><li>Mentor and educate SIU team members on clinical aspects of fraud schemes </li></ul> Required Qualifications: <ul><li>MD or DO with active license, preferably in emergency medicine or primary care </li></ul> <ul><li>5+ years of clinical practice experience </li></ul> <ul><li>Strong analytical and problem-solving skills </li></ul> <ul><li> Excellent communication and leadership abilities </li></ul> Preferred Qualifications: <ul><li>3+ years supporting healthcare fraud investigations or related field </li></ul> <ul><li>Board Certification in Emergency Medicine</li></ul> Education: <ul> <li>Active and current state medical license without encumbrances</li> <li>M.D. or D.O., Board Certification in a recognized specialty including post-graduate direct patient care experience</li> </ul> Pay 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: 07/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Medical Director - SIU (Special Investigations Unit)

Job Description: At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. We do this by driving Responsible Growth and delivering for our clients, teammates, communities and shareholders every day. Being a Great Place to Work is core to how we drive Responsible Growth. This includes our commitment to being a diverse and inclusive workplace, attracting and developing exceptional talent, supporting our teammates’ physical, emotional, and financial wellness, recognizing and rewarding performance, and how we make an impact in the communities we serve. At Bank of America, you can build a successful career with opportunities to learn, grow, and make an impact. Join us! The primary role of the Financial Solutions Advisor Stage I - Registration Candidate is to acquire the necessary registrations and training to become a Financial Solutions Advisor (FSA) Stage I. Primary responsibilities of FSA Stage I role, include: Provide end-to-end comprehensive advice and customized solutions to clients, helping them achieve their financial goals; Conduct client reviews/presentations, including a review of investment goals and recommended products such as stocks, bonds, mutual funds, banking, and managed money solutions; Engage and share value proposition with customers in the lobby; Triage client leads and make referrals to appropriate internal service providers based on client needs and asset thresholds; Participate in on-going training and interaction with the Merrill Lynch Wealth Management Complex; Communicate effectively; Strong computer skills with an ability to multitask in a fast paced environment; Ability to adapt and seek solutions for clients in a fast-paced environment. The role is a bridge between banking and brokerage, therefore the FSA Stage I must have a general awareness of core banking and investment solutions. Required Skills: Series 7 &amp; 66 must be obtained within 120 days; Series 7 and Series 66 (63 &amp; 65 accepted, in lieu of 66, if previously held) is required for FSA Stage I role. This position is subject to SAFE Act registration requirements. Pursuant to the SAFE Act requirements, all employees engaged in residential loan mortgage originations must register with the federal registry system and remain in good standing. Since your position requires SAFE Act registration, you will be required to register and to submit to the required SAFE Act background check and registration process. Failure to obtain and/or maintain SAFE Act registration may result in disciplinary action up to and including termination. Required Qualifications: <ul> <li>Demonstrates willingness to complete required industry licensing</li> <li>Displays confidence working in a sales role</li> <li>Builds strong client relationships through effective communication and collaboration</li> <li>Displays a proactive mindset and effective time management</li> <li>Demonstrates a results-driven mindset and prioritizes client interests</li> <li>Identifies appropriate client solutions through application of learnings and new information</li> <li>Applies relevant regulatory due diligence in daily activities and creating long-term client strategies</li> </ul> Desired Qualifications: <ul> <li>Bachelor’s degree and/or a minimum of one year of financial services industry or sales experience</li> <li>Learns and adapts to new technology or applications</li> <li>Executes multiple tasks simultaneously</li> </ul> Shift:1st shift (United States of America) Hours Per Week: 40

Bank of America

Financial Solutions Advisor Registration Candidate - Consumer Investments - Ross Town Center Financial Center

Job Description: At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. We do this by driving Responsible Growth and delivering for our clients, teammates, communities and shareholders every day. Being a Great Place to Work is core to how we drive Responsible Growth. This includes our commitment to being an inclusive workplace, attracting and developing exceptional talent, supporting our teammates’ physical, emotional, and financial wellness, recognizing and rewarding performance, and how we make an impact in the communities we serve. Bank of America is committed to an in-office culture with specific requirements for office-based attendance and which allows for an appropriate level of flexibility for our teammates and businesses based on role-specific considerations. At Bank of America, you can build a successful career with opportunities to learn, grow, and make an impact. Join us! Job Description: This job is responsible for managing a financial center and it's employees on a day-today basis. Key responsibilities include operating as a business owner and fostering a team environment, instilling an effective client-centric and risk culture in the center, and helping clients achieve the financial goals. Job expectations include ensuring operational excellence and cohesive effectiveness. Responsibilities: <ul> <li>Develops talent, including proactive sourcing of candidates</li> <li>Manages client traffic, engaging and appropriately routing clients, and fostering client retention</li> <li>Manages business results through formalized management routines and coaching</li> <li>Creates a world class client experience environment</li> <li>Manages market-level initiative prescribed by market leaders</li> <li>Drives operational excellence by engaging employees on business strategy</li> <li>Manages organizational priorities and effective execution</li> </ul> Managerial Responsibilities: This position may also have responsibilities for managing associates. At Bank of America, all managers at this level demonstrate the following responsibilities, in addition to those specific to the role, listed above. <ul> <li>Diversity &amp; Inclusion Champion: Creates an inclusive team where members are treated fairly and respectfully.</li> <li>Manager of Process &amp; Data: Demonstrates and expects process knowledge, data driven decisions, simplicity and continuous improvement.</li> <li>Enterprise Advocate &amp; Communicator: Delivers clear and concise messages that motivate, convey the “why” and connects contributions to business results.</li> <li>Risk Manager: Leads and encourages the identification, escalation and resolution of potential risks.</li> <li>People Manager &amp; Coach: Knows and develops team members through coaching and feedback.</li> <li>Financial Steward: Manages expenses and demonstrates an owner’s mindset.</li> <li>Enterprise Talent Leader: Recruits, on-boards and develops talent, and supports talent mobility for career growth.</li> <li>Driver of Business Outcomes: Delivers results through effective team management, structure, and routines.</li> </ul> Required Qualifications: <ul> <li>1+ years of leadership experience demonstrated through one or a combination of the following: coaching, training and/or motivating a diverse work team</li> <li>Is an enthusiastic, highly motivated self-starter with a strong work ethic and intense focus on results, acting in the best interest of the client</li> <li>Collaborates effectively to get things done, building and nurturing strong relationships</li> <li>Displays passion, commitment and drive to deliver an experience that improves our clients' financial lives</li> <li>Is confident in identifying solutions for clients based on their needs and can resolve problems independently or bring in others as needed</li> <li>Communicates effectively and confidently and is comfortable engaging all clients</li> <li>Has the ability to learn and adapt to new information and technology platforms</li> <li>Applies strong critical thinking and problem-solving skills to meet clients' needs</li> <li>Will follow established processes and guidelines in daily activities to do what is right for clients and the bank, adhering to all applicable laws and regulations</li> <li>Efficiently manages time and capacity</li> <li>Can manage complexity, prioritize tasks, delegate and execute in a fast-paced environment</li> <li>Can interpret performance results, find opportunities to drive success and hold others accountable to results</li> <li>Can be flexible to work weekends and/or extended hours as needed</li> </ul> Desired Qualifications: <ul> <li>1+ years of management experience including hiring, coaching and developing direct reports</li> <li>Experience in financial services and knowledge of financial services industry, products and solutions</li> <li>Experience working in an environment with individual and team goals where goals were routinely met or exceeded</li> <li>Bilingual skills​</li> </ul> Skills: <ul> <li>Coaching</li> <li>Customer Service Management</li> <li>Customer and Client Focus</li> <li>Performance Management</li> <li>Talent Development</li> <li>Business Operations Management</li> <li>Recruiting</li> <li>Result Orientation</li> <li>Risk Management</li> <li>Sales Performance Management</li> <li>Inclusive Leadership</li> <li>Leadership Development</li> <li>Prioritization</li> <li>Problem Solving</li> <li>Referral Management</li> </ul> Minimum Education Requirement: High School Diploma / GED / Secondary School or equivalent Shift:1st shift (United States of America) Hours Per Week: 40

Financial Center Manager - Penn Hills

About Working at Commerce Building a career here is more than just steps on a ladder. It’s about helping people find financial safety and success, helping businesses thrive, and making sure people and their money are taken care of. And our commitment doesn’t stop there. Our culture is about our people, the ones in our communities and the ones that work with us. Here, you’ll find opportunities to grow and learn, to connect with others, and build relationships with the people around you. You’ll have the space and resources to grow into the best version of yourself. Because our number one investment is you.Creating an award-winning culture doesn't come easy. And after 160 years, we know Commerce Bank is only at its best when our people are. If this sounds interesting to you, keep reading and let’s talk. Compensation RangeAnnual Salary: $70,500.00 - $121,000.00 (Amount based on relevant experience, skills, and competencies.)About This JobThe main purpose of this job is to sell card payment services to “C” level associates at targeted enterprise level businesses, hospitals, educational and government entities. These targeted companies may, or may not, have an established relationship with Commerce Bank.Essential Functions<ul> <li>Conduct sales calls using consultative business process reviews and move prospective client through the sales cycle from the first appointment to contract signing</li> <li>Set appointments with prospects through the telephone, email, and marketing campaigns</li> <li>Identify prospect goals and objectives for process improvement then recommend solutions to help meet these goals and objectives</li> <li>Provide value-added services including technical support, Product Development and Relationship Management</li> <li>Negotiate contract terms and pricing that will be appealing to the customer and deliver an acceptable return to Commerce</li> <li>Prepare customized request for information, request for proposal, file spend analysis, proposals and sales presentations</li> <li>Perform other duties as assigned</li> </ul>Knowledge, Skills &amp; Abilities Required<ul> <li>Ability to maintain a valid driver’s license and meet Commerce Bank’s driving record criteria; ongoing employment may be contingent upon meeting all driving requirements</li> <li>Strong understanding of business concepts including account payable, purchasing and accounting systems</li> <li>Strong knowledge of consultative sales process</li> <li>Strong data analysis skills</li> <li>Skilled at interacting with senior managers and able to develop a business case</li> <li>Able to work independently but with some oversight from direct supervisor</li> <li>Capable of managing relationships independently and in negotiating sales and contracts</li> <li>Superior presentation skills</li> <li>Motivated and organized self-starter with strong attention to detail and the ability to manage multiple priorities</li> <li>Inquisitive, agile and strong team player with excellent written, verbal and interpersonal communication skills</li> <li>Ability to remain adaptable and resilient to all situations with an optimistic outlook and cast a positive shadow that is aligned with our culture and Core Values</li> <li>Advanced level proficiency with Microsoft Word, Excel and Outlook</li> </ul>Education &amp; Experience<ul> <li>Bachelor’s degree in Business Administration or equivalent combination of education and experience required</li> <li>7+ years new customer acquisition sales experience required, preferably within the banking/financial services field</li> <li>Proven track record within the team selling and lead sharing environment required</li> </ul>For this position, Commerce Bank will review your motor vehicle driving record. If you express interest in and are considered for this position, you’ll be asked to authorize our review of that record.**Level of role is determined by knowledge, experience, skills, abilities, and education***For individuals applying, assigned and/or hired to work in areas with pay transparency requirements, Commerce is required by law to include a reasonable estimate of the compensation range for some roles. This compensation range is for the Account Executive I, II, III, and Senior – Commercial Card job and contemplates a wide range of factors that are considered in determining most appropriate job level and making compensation decisions, including but not limited to location, skill sets, education, relevant experience and training, licensure and certifications, and other business and organizational needs. The disclosed range estimate has not been adjusted for any applicable differentials (geographic, bilingual, or shift) that could be associated with the position or where it is filled. At Commerce, compensation decisions are dependent on the facts and circumstances of each situation. A reasonable estimate of the current base pay is $70,500 to $121,000 annually. This position will be eligible for additional compensation through performance-based incentive plan(s) that will correspond to meeting performance goals.#LI-RemoteThe candidate selected for this position may be eligible for the following employment benefits: employer sponsored health, dental, and vision insurance, 401(k), life insurance, paid vacation, and paid personal time. In addition, we offer career development, education assistance, and voluntary supplemental benefits. Click <a href="https://careers.commercebank.com/us/en/benefits" target="_blank">here</a> to learn more.Location: Remote, Boston, Massachusetts 02151Time Type:Full time

Commerce Bank

Account Executive - Commercial Card

Job Description: Merrill Wealth Management is a leading provider of comprehensive wealth management and investment products and services for individuals, companies, and institutions. Merrill Wealth Management is one of the largest businesses of its kind in the world specializing in goals-based wealth management, including planning for retirement, education, legacy, and other life goals through investment advice and guidance. Merrill’s Financial Advisors and Wealth Management Client Associates help clients pursue the life they envision through a personal relationship with their advisory team committed to their needs. We believe trust comes from transparency. Our trusted advisory teams are equipped with access to the investment insights of Merrill coupled with the banking convenience of Bank of America. At Merrill, we empower you to bring your whole self to work. We value diversity in our thoughts, business, and within our employees and clients. Our Wealth Management team represents an array of different backgrounds and bring their unique perspectives, ideas and experiences, helping to create a work community that is culture driven, resilient, results focused and effective. Job Description: This job is responsible for working with high-net worth clients with annual revenues of $100k-$5mm, identifying needs, developing relationships, reviewing investment goals, and preparing investment recommendations that align with the goals of both existing and prospective clients. Key responsibilities include leveraging technology to achieve business growth goals, profiling activities to determine a client's investor profile and financial resource objectives, building a sustainable book of business, and providing opportunities for advisors to pursue a career within the bank. This position is subject to SAFE Act registration requirements. Pursuant to the SAFE Act requirements, all employees engaged in residential loan mortgage originations must register with the federal registry system and remain in good standing. Since this position requires SAFE Act registration, employees are required to register and to submit to the required SAFE Act background check and registration process. Failure to obtain and/or maintain SAFE Act registration may result in disciplinary action up to and including termination. Responsibilities: Provides tailored and personalized advice to clients through reviews and presentations, including assessing financial goals and recommending investment advisory strategies Communicates solutions to clients that are best suited for their financial needs, such as core Banking, and Investment and Life Priority™ solutions Partners with Financial Advisor teams to build their network by sharing relevant market developments and discussing new products (as appropriate) in an effort to promote portfolio growth Understands and accesses the full breadth of resources across the bank to benefit clients or prospects Develops and grows a book of business to meet and exceed pre-defined financial targets to measure their ability to progress to the next phase as an advisor Prioritizes client requests and makes introductions to appropriate internal service providers based on client needs and asset thresholds The Advisor Development Program (ADP) Journey: During this stage of your journey, the Merrill Financial Solutions Advisor (MFSA) will help provide you with the necessary training and guidance through a defined path to become a successful and independent financial advisor. You will have the opportunity to work with both affluent and high net worth clients, identifying needs, developing relationships, reviewing investment goals, and preparing investment recommendations that align with the goals of both existing and prospective clients. In this role you will develop the relationship management skills necessary to operate in an Elite Growth Practice (EGP). From marketing yourself to managing your own practice, we’ll prepare you with everything you need as you develop within your role. The MFSA role provides experienced advisors the opportunity to pursue a career within Merrill Wealth Management. Once you have honed your skills and demonstrated success as a MFSA, you typically will progress into the next stage of training. Located in a Merrill branch. We’ll help you: Get training and one-on-one mentorship from managers who are invested in your success. You’ll enroll in our Academy to develop as an advisor; the potential for growth is yours! Build connections to grow your network and business. Starting at a Merrill branch, you’ll interact with Merrill financial advisors, institutional retirement participants and higher net worth clients. Deliver advice through client reviews/presentations with confidence, including reviews of financial goals, and recommend investment advisory strategies to help clients achieve their financial goals. Learn about the full suite of financial solutions. Connect clients to solutions that are in their best interest, such as core Banking, Investment &amp; Life Priority™ solutions, through Bank of America and Merrill to meet their financial needs. As a Merrill FSA, you can look forward to: A strong referral network from across the business to increase opportunities for affluent and high net worth client acquisition and provide access to partners who are specialists in their field. Marketing strategies to reach wider audiences with greater appeal. Ongoing professional development to deepen your skills and optimize your practice as the industry evolves. Potential Opportunities for professional growth. Leadership opportunities, including leading client and conference seminars. We’re a culture that: Is committed to building a workplace where every employee is welcomed and given the support and resources to build and advance their careers. Along with taking care of our clients, we want to be a great place for people to work, and we strive to create an environment where all employees have the opportunity to achieve their goals. Believes diversity makes us stronger so we can reflect, connect to and meet the diverse needs of our clients around the world. Provides continuous training and developmental opportunities to help employees achieve their goals, whatever their background or experience. Is committed to advancing our tools, technology and ways of working. We always put our clients first to meet their evolving needs. Believes in responsible growth and is dedicated to supporting communities around the world by connecting them to the lending, investing and giving they need to remain vibrant and vital. Required Qualifications: Currently holds Series 7 &amp; 66 (63 &amp; 65 in lieu of 66) licenses Two years' experience working in the financial service industry and/or a sales environment where goals were met or exceeded Minimum of one year experience in the investments industry, including investment training and in-depth knowledge of investment products and services Self-starter who efficiently manages time and capacity Sets and accomplishes goals, achieving whatever you put your mind to Builds and nurtures strong relationships Collaborates effectively with others to get things done Communicates effectively and confidently and is comfortable engaging all clients Manages goals, navigates complexity, prioritizes tasks and executes in a fast-paced environment Likes to learn, adapts to new information and seeks the right solutions for clients Thorough and thoughtful in incorporating relevant regulatory due diligence into daily activities and long-term strategies for clients Desired Qualifications: Proven ability to partner and promote lead generation Experience balancing investment management, sales activities, and new client development Strong computer skills and the ability to multitask in a demanding environment Bachelor's degree, preferably in business-related field Achieved additional professional designations such as Certified Financial Planner (CFP) and/or Chartered Retirement Planning Counselor (CRPC) Obtained insurance licenses ​ Skills: <ul> <li>Account Management</li> <li>Client Investments Management</li> <li>Client Management</li> <li>Client Solutions Advisory</li> <li>Relationship Building</li> <li>Advisory Business Development</li> <li>Fraud Management</li> <li>Pipeline Management</li> <li>Portfolio Management</li> <li>Client Experience Branding</li> <li>Issue Management</li> <li>Prospecting</li> <li>Referral Identification</li> <li>Sales Performance Management</li> </ul> Shift:1st shift (United States of America) Hours Per Week: 40

Merrill Financial Solutions Advisor - Western Pennsylvania Market

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.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

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director (Medical Affairs).This is a remote based, work from home opportunity. The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&amp;T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e.g., specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies. Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise’s decisions and planning. – Each Director is responsible for providing oversight of a portion of CVS Health's clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. – Directors will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. – Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i.e., Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage. –In this role you'll perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department. CVS Health, a Fortune 4 company, has an outstanding opportunity for a Medical Director (Medical Affairs). Required Qualifications * Family Medicine or Internal Medicine Board Certification.* Minimum of 5 years clinical experience in direct patient care. * 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs * Unrestricted license to practice medicine in the state in which the candidate is located. Preferred Qualifications * Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e.g., RNs, PharmDs, etc.). * ABMS or AOA Board Certified in a recognized medical specialty, preferably in a Primary Care field (Internal medicine, Family Medicine) * Master’s Degree in Public Health Administration or MBA preferred, UM/QA certification desired * Proficiency in MS Office Suite Education * Must be graduate of an accredited Medical School and Residency Program * Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia * Required annual Continuing Medical Education (CME) up to date and must remain current in medical and management areas during employmentPay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Medical Affairs)

<h3> Position Summary </h3> Position Summary As a Sr. GenAI Engineer, you will actively engage in your engineering craft, taking a hands-on approach to multiple high-visibility projects. Your expertise will be pivotal in delivering solutions that delight customers and users, while also driving tangible value for Deloitte's business investments. You will leverage your extensive GenAI &amp; engineering craftsmanship and advanced proficiency across multiple programming languages and modern frameworks, consistently demonstrating your exemplary track record in delivering high-quality, outcome-focused solutions. Recruiting for this role ends on 4.1.25 Work you’ll do <ul> <li> Outcome-Driven Accountability: Embrace and drive a culture of accountability for customer and business outcomes. Develop engineering solutions that solve complex problems with valuable outcomes, ensuring high-quality, lean designs and implementations.</li> <li> Technical Leadership and Advocacy: Serve as the technical advocate for products, ensuring code integrity, feasibility, and alignment with business and customer goals. Lead requirement analysis, contributing to low-level architecture and component design, development, unit testing, integrations, and support.</li> <li> Engineering Craftsmanship: Maintain accountability for the integrity of code design, implementation, quality, data, and ongoing maintenance and operations. Stay hands-on, self-driven, and continuously learn new approaches, languages, and frameworks with significant focus on infusing AI/ML/GenAI where possible/appropriate. Create technical specifications, and write high-quality, supportable, scalable code and review code of other engineers, mentoring them, to ensure all quality KPIs are met or exceeded. Demonstrate collaborative skills to work effectively with diverse teams.</li> <li> Customer-Centric Engineering: Develop lean engineering solutions through rapid, inexpensive experimentation to solve customer needs. Engage with customers and product teams before, during, and after delivery to ensure the right solution is delivered at the right time.</li> <li> Incremental and Iterative Delivery: Adopt a mindset that favors action and evidence over extensive planning. Utilize a leaning-forward approach to navigate complexity and uncertainty, delivering lean, supportable, and maintainable solutions.</li> <li> Cross-Functional Collaboration and Integration: Work collaboratively with empowered, cross-functional teams including product management, experience, and delivery. Integrate diverse perspectives to make well-informed decisions that balance feasibility, viability, usability, and value. Foster a collaborative environment that enhances team synergy and innovation.</li> <li> Advanced Technical Proficiency: Possess deep expertise in modern software engineering practices and principles, including AI/ML/GenAI, Agile methodologies and DevSecOps to deliver daily product deployments using full automation from code check-in to production with all quality checks through SDLC lifecycle. Strive to be a role model, leveraging these techniques to optimize solutioning and product delivery. Demonstrate strong understanding of the full lifecycle product development, focusing on continuous improvement and learning.</li> <li> Domain Expertise: Quickly acquire domain-specific knowledge relevant to the business or product. Translate business/user needs, architectures, and UX/UI designs into technical specifications and code. Be a valuable, flexible, and dedicated team member, supportive of teammates, and focused on quality and tech debt payoff.</li> <li> Effective Communication and Influence: Capable of articulating complex technical concepts clearly and compellingly. Inspire and influence teammates and product teams through well-structured arguments and trade-offs supported by evidence. Create coherent narratives that align technical solutions with business objectives.</li> <li> Engagement and Collaborative Co-Creation: Engage and collaborate with product engineering teams at all organizational levels, including customers as needed. Build and maintain constructive relationships, fostering a culture of co-creation and shared momentum towards achieving product goals. Align diverse perspectives and drive consensus to create feasible solutions.</li> </ul> The successful candidate will have and/or be able to: The ideal candidate will be a dependable team player and mentor, collaborating with cross-functional teams to design, develop, and deploy advanced software solutions. <ul> <li>Understanding and experience in managing big data of various forms to generate insights and create intelligence.</li> <li>Understanding of methodologies &amp; tools like, XP, Lean, SAFe, DevSecOps, SRE, ADO, GitHub, SonarQube, etc. to deliver high quality products rapidly.</li> <li>Excellent interpersonal and organizational skills, with the ability to handle diverse situations, complex projects, and changing priorities, behaving with passion, empathy, and care.</li> </ul> The Team US Deloitte Technology Product Engineering has modernized software and product delivery, creating a scalable, cost-effective model that focuses on value/outcomes that leverages a progressive and responsive talent structure. As Deloitte’s primary internal development team, Product Engineering delivers innovative digital solutions to businesses, service lines, and internal operations with proven bottom-line results and outcomes. It helps power Deloitte’s success. It is the engine that drives Deloitte, serving many of the world’s largest, most respected companies. We develop and deploy cutting-edge internal and go-to-market solutions that help Deloitte operate effectively and lead in the market. Our reputation is built on a tradition of delivering with excellence. Qualifications Required: <ul> <li>Bachelor's degree in computer science, software engineering, or related field.</li> <li>6+ years of engineering experience focused in AI/ML</li> <li>2+ years of recent experience in GenAI utilizing technologies such as: OpenAI, Claude, Gemini, LangChain, Agents, Vector databases and approaches like Prompt Engineering, fine-tuning, etc.</li> <li>Limited immigration sponsorship may be available</li> </ul> Preferred: <ul> <li>8+ years of engineering experience focused in AI/ML</li> <li>Prior experience in Python, R, TensorFlow, PyTorch, Keras, Julia, ML libraries, NLP.</li> <li>Prior experience with Angular, React, NodeJS, Python, Streamlit, C#, .NET Core, Golang, SQL/NoSQL.</li> <li>Prior experience with experience with cloud-native engineering, using FaaS/PaaS/micro-services on cloud hyper-scalers like Azure, AWS, and GCP.</li> <li>Prior experience and familiarity with XP, Lean, SAFe, DevSecOps, SRE, ADO, GitHub, SonarQube.</li> <li>Advanced degree (e.g., MS) in computer science, software engineering, or related field.</li> </ul> The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $102,500 to $ 210,600. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Information for applicants with a need for accommodation: Hyperlink: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> EA_ITS_ExpHire Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

19 Jobs in Home, PA 15747, USA