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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 SummaryAs a Senior Analyst, you will be responsible for using SQL, SAS, Tableau, MS Access, MS Excel, and related applications to determine disruption to existing and potential clients when network changes take place to retain and win business. This position involves making high-level decisions, managing multiple requests/priorities, developing new solutions to simplify the reporting process, and producing both standard and custom reports for multiple lines of business and specific clients regarding retail pharmacy network accessibility.Key Responsibilities:Data Management: Build queries, perform data imports and extracts, analyze data, compare networks, and create reports to support network disruption requests from internal customers (including Sales, Account Management, Membership Initiatives, Network Development, and Retail Analysis areas).Network Strategy Support: Support network strategies and initiatives through analytics reporting to project network disruption in various scenarios.Collaboration: Collaborate with team members on reporting initiatives and projects surrounding network disruption.Cross-Team Interaction: Attend meetings with Sales/Proposals and Network Disruption team leadership to clarify any custom requests from external consultants. Required Qualifications- 4 years previous work experience in Network Management or similar role.- Proficiency in SQL, SAS, Tableau, MS Access, MS Excel, and other relevant applications.- Strong analytical and problem-solving skills with the ability to interpret complex data sets.- Excellent verbal and written communication skills to effectively interact with internal teams and external clients.- Ability to manage multiple requests and priorities in a fast-paced environment. Preferred Qualifications- Working experience in the Pharmacy Benefits Management (PBM) or related healthcare industry. EducationBachelor's Degree in Computer Science, Information Technology, Data Analytics, or a related field or equivalent work experience. Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $91,800.00This 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: 03/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Senior Analyst, Network Disruption

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Oversee the overall client satisfaction for all accounts <ul> <li>Manage account renewal and retention processes and assist sales team in generating new client referrals</li> <li>Identify new services and profit enhancement opportunities within existing clients</li> <li>Collaborate with internal departments regarding client needs and requests, including understanding and interpreting contractual obligations to meet business needs</li> <li>Oversee the identification of client complaints and resolution of issues related to internal processes and systems</li> <li>Implement client specific corrective action plans and ensure timely submissions of complaints process</li> <li>Oversee the reporting and client documentation within Salesforce.com</li> <li>Research competitive intelligence and relevant market information to enhance client experience</li> <li>Facilitate development of custom proposals for new and existing clients</li> <li>Ability to travel</li> </ul>Education/Experience: Bachelor’s degree in Healthcare or Business Administration, Marketing, related field or equivalent experience. 7+ years of account management experience, preferably in specialty pharmacy, pharmacy benefit management, and/or a managed care environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.Pay Range: $110,900.00 - $205,000.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Oklahoma Complete Health

Director, Account Management

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members. Accountable for developing and implementing strategic programs to manage healthcare trends and drive population health solutions in collaboration with internal and external stakeholders. Individual will identify patient cohorts and develop a cohesive coordinated strategy for Medicare LOB and individual markets to manage trend for high cost (and at risk of high cost) members. Must work across the enterprise to communicate strategy and implement various pop health solutions to mitigate trend.<ul> <li>Lead a coordinated approach for the strategic analysis of utilization patterns, cost drivers, and emerging healthcare trends to develop targeted interventions that improve health outcomes and reduce costs.</li> <li>Provides deep industry expertise, thought leadership and consultative insights around best in class practices.</li> <li>Partner with providers, specialists, utilization management, care management, and select vendors to design and implement innovative solutions that optimize care delivery.</li> <li>Collaborate with key cross functional partners and Health Plans to assess trends and develop forecasts, ensuring sustainable strategies. Must be able to work across multiple departments to implement internal and external initiatives to mitigate trend</li> <li>Drive adoption of data-driven, risk adjusted care models to enhance disease management and preventive care strategies</li> <li>Translate strategic objectives from business transformation initiatives into actionable plans and ensure flawless execution of those plans.</li> <li>Develop, prioritize, and execute business process excellence initiatives to identify opportunities for operational efficiencies across the segment.</li> <li>Support successful contract implementation and development of new programs by developing and administering individual project plans, ensuring alignment with organizational goals.</li> <li>Conduct oversight meetings which include vendors, internal partners, and other stakeholders as appropriate.</li> <li>Establish, monitor, and report on vendor performance metrics.</li> </ul>Education and Experience Requirements:<ul> <li>Bachelor’s degree in business administration, Healthcare Administration or related field. Master’s degree in business, Finance or related field preferred. </li> <li>10+ years of experience in healthcare operations, finance, or clinical vendor management required. </li> <li>Strong expertise in Medicare cost trend analysis, population health management and value-based care models preferred. </li> <li>Proven track record of effectively engaging with members of Senior Leadership.</li> </ul>Pay Range: $182,100.00 - $345,600.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Staff Vice President, Medicare Trend and Strategy

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 SummaryFully remote position. Work from home anywhere in the U.S.A. Shift: Monday through Friday 11:30am to 8pm EST Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health.Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.<ul> <li>Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Provides triage and crisis support.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation.</li> <li>Coordinates with providers and other parties to facilitate optimal care/treatment.</li> <li>Identifies members at risk for poor outcomes and facilitates 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>Must have active current and unrestricted Independent clinical behavioral health license in the state of residence (LPC, LCSW, LMFT, LMHC, etc) </li> <li> 3+ years of behavioral health experience </li> <li>Must be able to talk on the telephone and type at the same time as this is a queue based position.</li> <li>Must be able to work Monday through Friday 11:30am to 8pm EST</li> </ul>​Preferred Qualifications<ul> <li>3+ years of direct clinical practice experience post master's degree, including hospital setting or alternative care setting such as ambulatory care or outpatient program</li> <li>Managed care and utilization review experience preferred.</li> <li>Crisis intervention skills preferred.</li> </ul>Education<ul><li>Master's degree required if social worker, LPC, LCSW, LMFT, LMHC, </li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$60,522.00 - $129,615.00This 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: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization management Clinician Behavioral Health

<h3> Position Summary </h3> Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Certified Systems Administrator (ECSA) you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you’ll do/Responsibilities We are seeking a highly skilled and certified Epic Client Systems Administrator (ECSA) to join our IT team. The ideal candidate will be responsible for the installation, configuration, and maintenance of Epic systems and related applications. This role requires a deep understanding of Epic infrastructure and the ability to ensure optimal performance and reliability of the Epic environment, preferably in a public cloud environment Key Responsibilities: <ul> <li>Install, configure, and maintain Epic client systems and applications in a public cloud environment</li> <li>Monitor system performance and troubleshoot issues to ensure optimal operation.</li> <li>Collaborate with Epic application teams to support and implement system changes.</li> <li>Manage and maintain system security and compliance with organizational policies.</li> <li>Provide technical support and training to end-users and other IT staff.</li> <li>Perform regular system updates and upgrades in coordination with Epic guidelines.</li> <li>Develop and maintain documentation for system configurations, processes, and procedures.</li> <li>Participate in on-call rotation to provide after-hours support as needed.</li> <li>Independently and collaboratively lead client engagement workstreams focused on improvement, optimization, and transformation of processes including implementing leading practice workflows, addressing deficits in quality, and driving operational outcomes</li> </ul> The Team Our Core Technology Operations (CTO) team offers differentiated operate services for our clients with solutions to help organizations scale and optimize critical business operations, drive speed to outcome, deliver business transformation, and build resilience in an uncertain future. Qualifications Required <ul> <li>Epic Certification: Must possess current Epic Client Systems Administrator (ECSA) certification.</li> <li>3-5 years of experience in IT systems administration, with at least 2 years specifically working with Epic systems.</li> <li>Proficiency in Windows Server and desktop operating systems.</li> <li>Experience with virtualization technologies such as VMware or Hyper-V.</li> <li>Strong understanding of network protocols and configurations.</li> <li>Familiarity with scripting languages (e.g., PowerShell, Python) for automation tasks.</li> <li>Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience</li> <li>Limited immigration sponsorship may be available</li> <li>Ability to work remotely, be on-call (rotation for after-hours support), ability to work flexible hours, including nights and weekends, as needed, travel 10% on average, based on the work you do and the clients and industries/sectors you serve</li> </ul> Preferred <ul> <li>Previous Consulting experience</li> <li>Experience with Epic Hyperspace, Interconnect, and Web BLOB</li> <li>Cloud knowledge such as AWS, GCP, Azure.</li> <li>Previous experience in a healthcare IT environment.</li> <li>Analytical ability to manage multiple projects and prioritize tasks into manageable work products</li> <li>Previous leadership experience preferred.</li> <li>Can operate independently or with minimum supervision</li> <li>Excellent written and communication skills</li> <li>Ability to deliver technical demonstrations</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 $97,875 to $145,000. 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: <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> 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-usdc.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.

Deloitte

Epic Certified System Administrator

<h3> Position Summary </h3> Deloitte’s Enterprise Performance professionals are leaders in optimizing operations that span the entire enterprise of an organization, from strategy to implementation and operation. By joining our team, you can help clients achieve impact and value from their investments in both people and technology that support enterprise-wide operations, as well as solutions for specific functions in the organization, from IT to finance and the supply chain. The team Deloitte’s Government and Public Services (GPS) practice – our people, ideas, technology and outcomes—is designed for impact. Serving federal, state, &amp; local government clients as well as public higher education institutions, our team of over 15,000+ professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise. The SAP Offering provides design, implementation, and ongoing operations and maintenance of SAP applications and technology. Deloitte is SAP’s #1 Partner in North America and works with clients to improve their ability to react in the digital world. Teams help enable scalability while also minimizing performance barriers, promoting innovation, modernizing core systems and helping clients reimagine their business with SAP digital solutions. Required Qualifications <ul> <li>Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future</li> <li>Must be able to acquire/maintain required level of Security clearance.</li> <li>Analyze documented requirements developed as a result of the analysis of the change request</li> <li>Develop technical design documents with the appropriate templates</li> <li>Expertise and hands on experience with S/4 data conversion with greenfield implementation</li> <li>Expertise and hands on experience in SAP Business Object Data Services</li> <li>Experience with S/4HANA data migration tools and ABAP</li> <li>Ability to source data from Oracle and load to HANA databases</li> <li>Strong knowledge of SQL and database development skills</li> <li>Develop an end-to-end process in SAP Data Services (BODS) which is fully automated with shell scripts and data flows</li> </ul> Preferred Skills <ul><li>Functional knowledge in SAP Finance, Funds Management and S/4 experience</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 $97,875 to $163,125. 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: <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-as…</a> 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-usdc.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our diverse, equitable, and 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. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-inclusion.html" target="_blank">Learn more about our inclusive culture.</a> 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.

SAP S/4 HANA Data Conversion Developer

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Project Manager will plan, organize, monitor, and oversee complex HR projects collaborating with cross functional teams such as HR and business stakeholders to deliver defined requirements and meet company strategic objectives.<ul> <li>Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure.</li> <li>Utilize corporate and industry standard project management tools and techniques to effectively manage projects.</li> <li>Assist with establishment and maintenance of corporate project management methodology and other department procedures.</li> <li>Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans.</li> <li>Provide leadership and effectively communicate project status to all stakeholders, may include written executive summaries.</li> <li>Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks.</li> <li>Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives.</li> <li>Provide functional and technical knowledge across multiple business and technical areas.</li> <li>Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation.</li> </ul>Education/Experience:<ul> <li>Bachelor's degree in Business Administration, Healthcare Administration, related field, or equivalent experience. Master's degree preferred.</li> <li>4+ years of project management and implementation or program management experience. Proficient with MS Office applications and project management tools including Smartsheet.</li> <li>Experience working with and leading diverse groups and matrix managed environments.</li> <li>Experience managing projects within Human Resources highly preferred.</li> </ul> License/Certification: PMP, PgMP, or CAPM preferred.Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Human Resources Project Manager III

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 is currently looking for a dynamic individual to join our team in an Sr. Analyst role. This is a client facing project management / auditor position that is responsible for coordinating, managing, tracking, reviewing, researching and assisting with multiple complex audit activities initiated by CMS / States. In this position, the Sr. Analyst will work closely with multiple clients and various Government / State auditors, the client account team, legal, and many other internal departments to ensure the completion of requested audits with consistency and minimal disruption to the business. This position needs to be able to manage many audits at the same time with short turnaround times. The Sr. Analyst will be responsible for the timely and satisfactory resolution of exceptions identified during the audit process, specifically related to pharmacy claims and manufacturer rebates. This includes having a working knowledge base around pharmacy claim adjudication principles, such as (but not limited to) benefit setup, discount pricing, prior authorizations, formulary, and accumulation tracking in order to review and respond to all the auditor’s questions in a short window of time. This position will also be expected to identify process enhancement opportunities to reduce or eliminate risk of future audit exceptions, as well as ensuring any concerns / issues are raised immediately to senior management. Skills must include abilities to analytically identify, track and encourage business owners in process enhancement opportunities to reduce risks, as well as researching claim specific questions. As a Sr. Analyst of Client Audit, you will be responsible for the following:<ul> <li>Work directly with the government auditors, the client and all the internal business areas involved in the audit</li> <li>Manage the work load successfully as there is no room for error with government audits and these audits come in waves across many clients at the same time which the position needs to be able to juggle all of the competing priorities</li> <li>Work independently with limited direction from the Director</li> <li>Coordinate, manage, track the audits from start to closure</li> <li>Review and researching all questions from the auditor and client </li> <li>Work through and resolve any alleged issues; working strategically and achieving results </li> <li>Respond back to the auditor / client</li> <li>Raise appropriate at risk items to the Director timely</li> <li>Documenting correspondence with internal partners, clients, and auditors</li> <li>Tracking all audit progress to ensure that all deliverables are provided by due dates</li> </ul>The ideal candidate will possess the following:<ul> <li>Understanding of pharmacy claim adjudication</li> <li>Understanding of pharmacy manufacturer rebates</li> <li>Ability to actively seek new ways to grow and be challenged</li> <li>Critical thinking which translates into strategic actions</li> <li>Easily adapting to change</li> <li>Excellent verbal and written communications skills</li> <li>Strong Project Management skills that include the ability to adapt and deal effectively in dynamic, possibly unpredictable, environments while efficiently managing multiple projects from initiation through to completion. A working contributor responsible for each project’s success.</li> <li>Ability to interact effectively with Government Auditors and Clients while under pressure during an audit is a must. Strong tolerance for ambiguity and stress</li> <li>Strong ability to maintain attention to detail and organizational skills.</li> <li>Strong ability to hold oneself and others accountable for mitigating risk and achieving results.</li> </ul> Required Qualifications3+ years of prior relevant experience in audit and/or project management Preferred QualificationsProject management experience.Proficiency in Microsoft Word, Excel, PowerPoint.PBM experience.CPA, CIA, or MBA EducationBS/BA required or equivalent years of education and experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $112,200.00This 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: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Analyst - Client Audit

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 Analyst will develop test plans, test cases and test scripts for projects, among other assigned duties. The Analyst will perform testing on various software and reporting systems. The Analyst will work closely with PA Admin and Medicare Operations to test and validate the utilization management (UM) criteria, decision trees, drug lists, and letters that are loaded and functioning properly in the PA (MHK) system. Also, the analyst will be responsible for configuration quality control, code testing and test case writing. Additional responsibilities: include ensuring the quality of PA Admin products for internal/external business users by testing cases and doing regression testing. As a Analyst developing and executing formal test plans to ensure the delivery of quality software and to ensure that all information systems products and services meet minimum organization standards and end-user requirements. Required Qualifications - 1 plus years of quality assurances or testing - 5 plus years Software knowledge (MS Office Suite including Access and Project) Preferred Qualifications - PBM Knowledge - Analytical Skills - Ability to work in teams or independent - Time Management skills - Medicare Knowledge - Able to thrive in time sensitive situations - Written and Verbal Communication Skills - IT certification Education Bachelor’s degree or Equivalent work experience Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $85,068.00This 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: 03/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Analyst, Clinical Services

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: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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