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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary: The Lead Director is responsible for leading and optimizing functions within the New Plan Build as well as future operation areas, including all internal resources and outsourced support. This role will administer the strategy for monitoring and improving operational functions aligning policies and procedures with organizational objectives. Controls performance management and contributes to top-level decision making for the Customer Facing Operations Organization. This individual will develop and implement a comprehensive roadmap for Plan Build to enhance client satisfaction, drive operational efficiency, and foster continuous improvement. The ideal candidate will be a strategic leader with a deep understanding of Implementation/Onboarding best practices and technology solutions.Key Responsibilities:<ul> <li>Leads continuous improvement initiatives to enhance Plan Build management processes, increase efficiency, and reduce defects across the organization.</li> <li>Collaborates with various departments, such as Core Operations - Claims, Implementation/Onboarding, Eligibility, Appeals, Compliance and Client Management, to ensure quality considerations are integrated into all aspects of the organization's operations.</li> <li>Collaborate with cross-functional teams, including Client Management, Local Market Development, IT and others to drive a customer-centric culture and improve service touchpoints. Develops and maintains strong collaborative relationships maintain excellent lines of communication and share resources to meet common service center objectives.</li> <li>Establishes and maintains a robust Plan Build quality management system by developing quality policies, procedures, and guidelines that comply with industry standards and regulatory requirements.</li> <li>Analyzes data and generates regular reports on KPIs and metrics using data-driven insights to communicate quality performance to senior management.</li> <li>Manages the budget and allocates resources effectively to support operation and improvement efforts.</li> <li>Provides leadership and guidance to department teams and direct reports, overseeing their work, conducting performance evaluations, and providing training and development opportunities.</li> <li>Responsible for bringing forward new technology and service processes that will result in improved member and provider experiences, while also driving efficiencies in the customer service organization.</li> <li>Manage and optimize relationships with future outsourcing partners to ensure performance, cost-effectiveness, and seamless integration with internal operations.</li> <li>Implement and leverage technology solutions, such AI chatbots and other automation tools, to enhance service capabilities.</li> <li>Sets strategic direction and influencing change that resulted in quantifiable positive outcomes.</li> <li>Ensures regulatory compliance.</li> <li>Develop and implement training programs to ensure teams are equipped with the skills and knowledge to provide exceptional support.</li> <li>Stay informed of industry trends, customer expectations, and emerging technologies to maintain a competitive edge.</li> </ul>Required Qualifications:<ul> <li>5+ years' experience in managing high volume transaction processing, financial management, project delivery, production, systems analysis and application. </li> <li>5 + years' management and leadership experience.</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> <li>Adept at business intelligence</li> </ul>Preferred Qualifications:<ul> <li>Mastery of problem solving and decision-making skills</li> <li>Mastery of growth mindset (agility and developing yourself and others) skills</li> </ul>Education:Bachelor's degree in a closely related field, or equivalent combination of education and experience.Pay RangeThe typical pay range for this role is:$100,000.00 - $231,540.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Lead Director, Service 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.Requisition Job DescriptionPosition Summary We are excited to invite a highly motivated and detail-oriented Project Manager to join our team. The Project Manager will part of the Network Platform Solutions – Contracts &amp; Pricing Team to support Medicaid Contracting IT projects in Conga and to provide support to Network for Conga contracting needs.Responsibilities Include:<ul> <li>Support of ECOM releases for Conga</li> <li>Assist with ongoing management of Conga system enhancements and fixes</li> <li>Ongoing management may include project planning, documentation of requirements, and review of IT design/development, user acceptance testing, system implementation, and performing post-release checkout</li> <li>Act as Project Manager/subject matter expert on Conga Medicaid Contracting for all Medicaid Network plans and Duals plans</li> <li>Assist in conducting research associated to business system issues and development of workarounds and communications of identified issues</li> <li>Collaborate with L&amp;P on development and delivery of training vignettes for Conga CLM</li> <li>Review of state-approved templates and regulatory compliance addendum documents to ensure clarity, accuracy, and compliance with legal standards and internal policies</li> <li>Maintain reports and dashboards for executive leadership and Medicaid Health Plans</li> <li>Support of internal and external audit requests for Conga Medicaid contracting</li> </ul>Required Qualifications<ul> <li>3 to 5 years Medicaid experience</li> <li>2 to 3 years contract management and processes</li> <li>2 to 3 years project management experience</li> <li>Strong problem-solving and decision-making skills</li> <li>Strong analytical skills and attention to detail</li> <li>Excellent communication and collaboration skills</li> <li>Ability to adapt to changing priorities and work effectively under pressure</li> <li>Demonstrated ability to learn new concepts</li> <li>Demonstrated ability to successfully deliver assigned projects</li> </ul>Preferred Qualifications<ul> <li>Familiarity with Conga CLM</li> <li>Familiarity with Duals contracting processes</li> <li>Demonstrate curiosity when identifying issues and pursuing solutions and providing ideas to improve processes</li> <li>Proficiency in Microsoft: Excel, Word, and Teams</li> <li>QuickBase and SharePoint user experience</li> </ul> Education Bachelor's Degree or equivalent experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Project Manager-Medicaid Contracts and Pricing

Cherokee Nation Businesses

Federal Business Development Manager Engineering & Manufacturing

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 SummaryProvides leadership and maintains oversight of functions over the Meritain Health Network Operations Team. Executes local strategic and operational plan in support of business segment customer service objectives and initiatives. Plans, directs, and implements procedures that will assure a high level of customer access and satisfaction. Responsible for the quality and effectiveness of own team and related teams, identifying and resolving technical, operational and team problems. Manages a team of professional employees.Required Qualifications<ul> <li>5+ years of being a people leader</li> <li>5+ years of experience in managing high volume operational work with network implementations, network configurations, maintaining provider files/fee schedules, and coordinating online provider directories.</li> <li>Proven strong leadership skills managing high-performance teams, setting strategic direction, and influencing change that resulted in quantifiable positive outcomes.</li> <li>Demonstrated issue resolution with a sense of urgency.</li> <li>3 to 5 years Healthcare industry experience required.</li> </ul>Preferred Qualifications<ul> <li>Network or Provider related experience.</li> <li>Vendor Management.</li> </ul>EducationBachelor's degree or equivalent experience.Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/16/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Manager, Network 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 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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