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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 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.

CVSHealth

Medical Director (Medical Policy & Operations)

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote-CA. ***Must reside in California***Healthcare lead experience with claims, appeals, and grievance strongly preferred.Position Purpose: The Supervisor of Appeals &amp; Grievances is accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they receive, investigate and resolve member complaints, member grievances, and provider disputes. This position is also responsible for the coordination of the resolution of grievance situations requiring competent and effective resolution in compliance with legal and regulatory requirements. This position will also perform initial and ongoing training in necessary skills and knowledge base and will assist Manager of Grievance and Appeals to establish and maintain procedures for Unit to maximize both outcomes and operational efficiency.<ul><li>Provides daily supervision for Grievance and Appeals Unit, including coordination of backup staffing, cross-training and deployment.</li></ul><ul><li>Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non-clinical Grievance and Appeals staff.</li></ul><ul><li>Orients and trains new Grievance and Appeals Unit members.</li></ul><ul><li>Continually trains Unit members concerning grievances, appeals, and provider disputes/appeals.</li></ul><ul><li>Regularly audits work of G&amp;A Specialists and reports results.</li></ul><ul><li>Coordinates investigation and resolution of complex appeal and grievance issues.</li></ul><ul><li>Provides approval decisions involving grievance and appeal determinations.</li></ul><ul><li>Coordinates maintenance and updates of desktop procedures and manuals for Unit.</li></ul><ul><li>Assists in the establishment of grievance operating procedures.</li></ul><ul><li>Prepares reports as required and performs trend analyses.</li></ul><ul><li>Participates in Health Plan audits as needed.</li></ul><ul> <li>Performs other related duties as required.</li> <li>Performs other duties as assigned</li> </ul><ul><li>Complies with all policies and standards</li></ul>Education/Experience: High School Diploma. Bachelor’s Degree preferred. 5+ years of experience in Managed Care. 2+ supervisory experience preferred.Pay Range: $26.50 - $47.59 per hourCentene 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

Supervisor, Appeals Grievance (State)

<h3> Position Summary </h3> The Human Capital Offering Portfolio focuses on helping organizations manage and improve their performance through their most important asset: their people. To stay in front, organizations need to have real-time access to Human Capital insights, experts and innovative technology solutions that are designed to not only drive but sustain and extend organizational performance and engagement. Supporting the products and capabilities of the Human Capital Offering Portfolio, our team is full of passionate, energetic, and multi-talented engineers who are excited about building the world’s greatest personalized and business friendly applications. This role is central to Deloitte’s Human Capital Team, and will spearhead, plan, coordinate, and deliver a variety of Generative AI projects. You will be responsible for leading one or more complex Generative AI projects, including project timeline, scope prioritization, cost, dependencies, and performance risks. This person must be an expert in communication, technology project management, understanding the overall product roadmap, technology stack, application suite, business processes and any downstream system and business impacts. They will collaborate with internal and vendor peers, executives, and line of business partners to ensure the success of projects. Recruiting for this role ends on 5/31/25 Join this team: We’re seeking a highly motivated and experienced Project Manager (PM)/Scrum Master (SM)/Manager with AI experience. This person will help build Human Capital solutions used by the biggest and most influential businesses around the world. Responsibilities: * Collaborate / Align technical and non-technical team members to translate customer needs into world-class solutions * Play a key role in bridging technical and business aspects of AI projects, ensuring that the scopes are feasible, aligned with technical capabilities' roadmap, market maturity, and targeted towards tangible business values * Lead / Coach teams new to Agile / Scrum methodologies * Collaborate with the business to prioritize and define Epics and User Stories * Document User Stories and Acceptance criteria in Jira * Identify / Manage / Mitigate risks to prevent issues * Align / Ensure end-to-end solution success and readiness * Work collaboratively to guide new teams thru the forming, storming, and norming phases * Provide / Accept continuous feedback in the spirit of continuous improvement * Ensure Scrum ceremonies are collaborative, occur on time, and adhere to "best practice" * Promote a healthy and sustainable work environment by using teams’ average velocity to properly size Sprints * Coordinate cross functionally to remove blockers and manage dependencies * Continuously drive execution and accountability * Monitor / Communicate solution status * Determine what’s important and make solution decisions in the absence of clear guidelines or Product Owner participation * When needed, do "whatever it takes" to ensure success * Coach junior PMs / SMs / BAs Required Qualifications: * Bachelor's degree * GenAI/Machine Learning certification * Scrum Master Certification * PMP or other accredited Project Management certifications * 4+ years of experience in Agile/Scrum * 4+ years of JIRA/Confluence experience * 4+ years of familiarity with cloud technologies (AWS, GCP, Azure) * 1+ years of experience leading cross-functional teams to identify, scope, and build GenAI/Machine Learning solutions * 1+ years of experience with Large Language Models (LLM) * 2+ years coaching junior level team members * 2+ years of experience with financial/budget management and complex cost-benefit analysis * 2+ years of experience prioritizing/managing a Portfolio of related projects * Ability to travel 0-25%, on average, based on the work you do and the clients and industries/sectors you serve. * Limited immigration sponsorship may be available Preferred Qualifications: * Bachelor’s degree in Computer Science or Engineering * Excellent verbal/written communication skills * Understanding of AI product management methodologies * Agile Certifications (CSM; ACP; CSPO; SAFe; LeSS) * Excellent organizational skills * Attention to detail and follow up * Past development experience * DevOps awareness * Experience with HRM Systems - SAP, Oracle, SuccessFactors, Workday 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> Possible Locations: Atlanta, Austin, Baltimore, Birmingham, Boca Raton, Boise, Boston, Charlotte, Chicago, Cincinnati, Cleveland, Columbus, Costa Mesa, Dallas, Davenport, Dayton, Denver, Des Moines, Detroit, Fort Worth, Fresno, Grand Rapids, Harrisburg, Hartford, Houston, Indianapolis, Jacksonville, Jersey City, Kansas City, Las Vegas, Los Angeles, Louisville, McLean, Memphis, Miami, Midland, Minneapolis, Morristown, Nashville, New Orleans, New York, Philadelphia, Pleasanton, Pittsburgh, Portland, Princeton, Raleigh, Richmond, Rochester, Rosslyn, Sacramento, Salt Lake City, San Diego, San Francisco, San Jose, Seattle, St. Louis, Stamford, Tampa, Tempe, Tulsa, Washington DC 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 $144,600 to $241,000. 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. For more information about Human Capital, visit our landing page at: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-human-capital-consulting-jobs.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-human-capital-consulting-jobs.html</a> #HC25 #HCaaS25 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.

Deloitte

GenAI/Machine Learning Technical Project Manager

<h3> Position Summary </h3> Tired of Tax Compliance and Busy Season? You’ve earned your stripes as a tax specialist and tapped into the world of cutting-edge tax technology. You are not an expert in technology, but you can offer profound insight about how U.S. federal income tax models and computations work. If you have a passion for improving computational software applications and proprietary solutions, we have the career opportunity to keep you buzzing! Work You’ll Do: As a Tax Sr. Manager in our Partnership Solutions Group, Operational Partnership Services team you will: <ul> <li>Refine your skillset with the ability to work with large-scaled operating partnership tax clients on matters that mean the most to them.</li> <li>Diversify your industry experience by working on a plethora of various industries including private equity, healthcare, tech, financial products, oil &amp; gas, green energy, real estate, consumer products, and other various industries.</li> <li>Deliver value to client experiencing a public offering (including SPACs) and interact with external counsel, underwriters, client executives, and capital market professionals through the SEC public filing process.</li> <li>Assist our client with public offering transactions including but not limited to initial proxy and registration statements for Up-C and SPAC structures.</li> <li>Work with Up-C clients on an on-going basis during periodic service periods during the year.</li> <li>Develop an understanding of the public monetization transactional process, including tax receivable agreements.</li> <li>Create cutting-edge technology that evolves around U.S. federal income tax principles for partnership tax, data analytics, and the user experience.</li> <li>Lead engagement teams and have the opportunity to work with highly motivated and dedicated teams. Mentor and develop of engagement staff, providing leadership, counseling, career guidance, and guidance on issues related to work/life fit.</li> <li>Implement strategic tax structures and processes, and oversee complex tax computation projects for clients, with emphasis on identification and communication of technical tax and service issues.</li> <li>Determine and solve for complexities with the U.S. federal income tax impact of public offerings.</li> <li>Participate in marketplace activities, recruiting, and process and technology innovation.</li> <li>Identify service opportunities, manage client accounts, and advance various Deloitte initiatives.</li> </ul> The Team: National Federal Tax Services (NFTS) is a national practice within Deloitte Tax LLP made up of a number of tax service offerings. Each NFTS service offering has been developed and built as a result of a tax planning idea, a marketplace driver, or a technological innovation - all with the purpose of delivering results for our clients. Our people are entrepreneurial in spirit and have always had the work-hard/play-hard mentality. NFTS service lines provide tax planning for the largest organizations across all industries. In the Operational Partnership Services (OPS) service line, which is a part of the Partnership Solutions Group within NFTS, OPS professionals counsel privately-held and publicly-traded partnerships across the United States on a wide range of federal tax and issues involving Up-C, mergers, acquisitions, divestitures, initial public offerings (IPO), post-offering assistance, and process design and improvement. Industries served by the Operational Partnership Services practice include private equity, real estate, telecom, technology, healthcare, media &amp; entertainment, energy, retail, and financial services that frequently involve asset management, venture capital, and international outbound joint ventures. Come join the team! Qualifications: Required: <ul> <li>Ability to perform job responsibilities within a hybrid work model that requires US Tax professionals to co-locate in person 2 – 3 days per week</li> <li>8+ years of experience in federal partnership tax</li> <li>Bachelor’s degree in accounting or other business-related field required</li> <li>Proven leadership skills demonstrating strong judgment, problem-solving, and decision-making abilities</li> <li>Proven management experience indicating strong organizational skills and the ability to plan and manage budgets and workplans</li> <li>Demonstrated U.S. federal income tax partnership experience</li> <li>Ability to travel up to 25%, on average, based on the work you do and the clients and industries/sectors you serve</li> <li>One of the following, active accreditations obtained:</li> <ul> <li>Licensed CPA in state of practice/primary office if eligible to sit for the CPA</li> <li>If not CPA eligible:</li> <ul> <li>Licensed Attorney</li> <li>Enrolled Agent</li> <li>Certifications:</li> <ul> <li>Chartered Financial Advisor (CFA)</li> <li>Certified Financial Planner (CFP)</li> </ul> </ul> </ul> </ul> Preferred: <ul> <li>Advanced degree such as master’s in science of tax (MST), JD, or LLM</li> <li>Previous Big 4 or large CPA firm experience</li> <li>Aptitude in MS Project, Word, Excel, and Visio</li> <li>Transaction and M&amp;A experience</li> <li>Alteryx experience</li> <li>Self-starter with demonstrated ability to effectively handle multiple, competing priorities</li> <li>Numerical-problem-solving focus</li> <li>Demonstrated effective verbal and written communication skills</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 $103,320 to $235,170. 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> nftstax btstax 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 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.

4 Operations Jobs in Maryland