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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 Appeal Supervisor (Meritain Health) develops and manages a team, in an effort to address matters regarding complaints and appeals, ensuring compliance with federal and/or state regulations. Leads the development of policies, procedures, and programs to ensure compliance with policies of all applicable federal and/or state government agencies.In this role, you will:<ul> <li>Manage the overall workflow of appeals as assigned.</li> <li>Provide coaching &amp; mentoring for a team of several analysts, specifically involving the handling of reviews.</li> <li>Ensure that any &amp; all compliance deadlines are adhered to and met.</li> <li>Assist in updating any relevant policies and procedures.</li> <li>Handle various escalated items, specifically related to appeals.</li> </ul>Required Qualifications<ul> <li>3+ years of experience working with appeals, including knowledge of job aids and workflows.</li> <li>2+ years of experience leading a team.</li> <li>Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).</li> </ul>Preferred Qualifications<ul> <li>2+ years of experience working with audits.</li> <li>2+ years of experience in training others.</li> <li>Product knowledge and experience with Appeals Regulatory Requirements.</li> <li>Strong communication skills, particularly with the ability to provide and receive feedback.</li> <li>Excellent time management skills.</li> <li>Ability to work collaboratively across teams.</li> <li>Strong analytical skills, focusing on accuracy and attention to details.</li> <li>Bachelor’s degree.</li> </ul> EducationHigh school diploma or GED.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $102,081.00This 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: 06/16/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Appeal Supervisor (Meritain Health)

U.S. Department of Veteran Affairs

Supervisory Social Science Program Coordinator

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.How will this role have an impact?The Executive Assistant will support technology executives in their day-to-day schedule management, meeting preparation, expenses, and a number of ad hoc work-related projects. This person will be the gatekeeper for the VPs and will help them prioritize and communicate with internal and external stakeholders in a timely, professional manner.What will you do?<ul> <li>Supporting technology executives in day-to-day activities including the coordination and management of meetings and daily schedule.</li> <li>Coordinate meetings, including booking rooms, and preparation of materials</li> <li>Manage expenses and submit expense reports in Concur</li> <li>Coordinate travel arrangements</li> <li>Assist with team events across multiple sites</li> <li>Arrange and execute team building, offsites, and social events/lunches</li> <li>Liaise with Technology and facilities departments regarding software, equipment, and office needs</li> <li>Ad hoc projects as needed</li> </ul>We are looking for someone with:<ul> <li>3+ years of experience in a supporting role for c-level executive</li> <li>Experience using G-Suite</li> <li>Proven professional organizational and time management skills</li> <li>Excellent interpersonal skills</li> <li>Track record of problem solving and critical thinking</li> </ul>Education<ul><li>Bachelor's degree preferred/specialized training/relevant professional qualification.</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$22.59 - $58.85This 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: 06/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Executive Assistant - Technology and AI

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 Enrollment Representative position will be supporting multiple health plans. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data. • Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; •Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.(*) • Monitors daily status reports assessing output for developing trends potentially impacting service levels. (*) • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) • Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization. (*) • Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). (*) • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. (*) • When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. (*) • Interprets and translates client benefits and supporting account structure against internal systems/applications(i.e.,GEBAR, AAS, and CCI). (*) • Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. • Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients. Required Qualifications <ul> <li>Attention to detail and accuracy.</li> <li>Problem solving skills.</li> <li>Strong organization skills.</li> <li>Understands the impact of work to other teams and downstream support areas.</li> <li>Ability to analyze and research data to make appropriate corrections as necessary.</li> <li>Strong verbal and written communication skills.</li> <li>Workplace flexibility - ability to adapt to change.</li> <li>Required to maintain work schedule within EST time zone (9:30am- 6:00pm EST).</li> <li>Ability to remain available for overtime, with possible weekend work where needed.</li> </ul> Preferred Qualifications <ul> <li>Knowledge of Health Care and/or MCO’s.</li> <li>Knowledge of Enrollment.</li> <li>Knowledge Medicaid and/or Medicare.</li> <li>Knowledge and comfortability with learning different systems and using Excel (VLOOKUP).</li> </ul> Education <ul><li>High School Diploma or equivalent.</li></ul> Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Eligibility Consultant

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryAetna, a CVS Health company has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy &amp; Operations) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. The Primary Responsibilities of the Medical Director include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will: ◾Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. ◾Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests.◾Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. ◾ Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. ◾Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. ◾Work Collaboratively with the functional areas. Required Qualifications*Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. *M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Preferred Qualifications* Health plan/payor experience. * Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Strong communication skills both written and verbal. Education* M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experiencePay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/14/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Medical Policy & Operations)

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position Summary <h3>Accountable for driving innovation and operational excellence from ideation to delivery for small to moderate scale, complex, high value initiatives and parts of larger initiatives that impact the delivery of products and services to the internal and external environment.</h3> <ul> <li><h3>Evaluating, designing, and implementing new growth strategies</h3></li> <li><h3>Partnering cross-functionally to identify colleague and customer needs and develop solutions and tactics to drive growth</h3></li> <li><h3>Tracking progress against key milestones, and creating and implementing value-based metrics and analysis to measure outcomes</h3></li> <li><h3>Delivering quantitative and qualitative analyses with slide presentations and storytelling that will simplify complex problems into simple for solutions for leadership to weigh in on</h3></li> <li><h3>Assisting in creating executive level readouts and presentation materials for leadership</h3></li> <li><h3>Developing dashboards to be leveraged by key stakeholders to monitor performance of our business</h3></li> <li><h3>Conducting deep dive analytics to identify opportunities for innovation and process improvement</h3></li> <li><h3>Performing root cause analysis and ad hoc research to diagnose gaps in our workflow and patient experience</h3></li> <li><h3>Simplifying complex datasets and identifying actionable insights that drive value</h3></li> </ul> <h3>This job might be for you if:</h3> <ul> <li><h3>You're energized by being part of a large cross functional team working in a fast-paced environment. You enjoy working in teams with a diverse set of experiences and backgrounds. You listen to others’ ideas with an open mind.</h3></li> <li><h3>You’re a leader. And you know this means more than leading people. You know that it means taking initiative with a project - anticipating the next steps and taking action before asked. You also know that it can mean leading from behind and stepping in with much needed support.</h3></li> <li><h3>You enjoy solving complex problems. If you don’t know how to do something, you work to find the answers. You don’t get frustrated easily when something doesn’t go the way you planned.</h3></li> <li><h3>You can take complicated concepts and communicate them effectively to a variety of audiences. You write well. You pay attention to the details. You can articulate your thoughts eloquently. You have a track record of successfully influencing senior leadership and clients.</h3></li> <li><h3>You are self-motivated. You take ownership of your work and your team’s work. You pay attention to the details. </h3></li> <li><h3>You enjoy spending your weekends reading the health section of the paper or listening to healthcare podcasts. You’re interested in tracking how the industry is evolving and like understanding the intricacies of it.</h3></li> <li><h3>You love numbers and can track a multitude of key operational and financial metrics with ease</h3></li> <li><h3>You “think big” and encourage others to take calculated risks in exploring unconventional ideas and challenging the status quo</h3></li> </ul> <h3> Required Qualifications </h3> <ul> <li><h3>7+ years of experience in healthcare in a role that involves strategic problem solving and/or new product development (e.g., consulting)</h3></li> <li><h3>7+ years of demonstrated organizational skills (e.g. project management experience or managing cross-team/department initiatives with demonstrated success)</h3></li> <li><h3>5+ years of data analytics experience working with large data sets and using Excel, SQL, Python, and/or other equivalent analytics tools</h3></li> <li><h3>5+ years leading cross-functional teams in a matrixed environment</h3></li> </ul> <h3> Preferred Qualifications </h3> <ul> <li><h3>Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.</h3></li> <li><h3>Demonstrated leadership with relevant initiatives: Business process, enterprise business project strategic planning and analysis, risk management, public health, process improvement (e.g., Lean Six Sigma certification).management/consulting. </h3></li> <li><h3>Demonstrated superior business process, project management.</h3></li> <li><h3>Demonstrated experience successfully implementing change in complex organizations.</h3></li> <li><h3>Experience with enterprise-wide and/or cross-functional large scale initiatives with high degree of complexity.</h3></li> </ul> <h3>Education</h3> <ul><li><h3> Masters degree preferred, but not required. Bachelor's degree required or equivalent experience.</h3></li></ul> Pay RangeThe typical pay range for this role is:$82,940.00 - $182,549.00 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 02/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Manager Project Management

Overview Are you looking for a rewarding career? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay $90,000.00- $105,000.00 annually Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. What's in it for you <ul> <li>A full benefits package with choice of affordable PPO or HSA medical plans.</li> <li>Paid time off.</li> <li>Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan.</li> <li>Up to $500 in wellness rewards for completing activities during the year. Use these rewards to support your wellbeing with spa services, gym memberships, sports, hobbies, pets and more.*</li> <li>Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program.</li> <li>401(k) with a company match.</li> <li>Family support with infertility treatment coverage*, adoption reimbursement, paid parental and family caregiver leave.</li> <li>And more.</li> </ul> Please note: Benefit eligibility can vary by position depending on shift status. *To participate, you must be enrolled in an Amedisys medical plan. **For full-time caregivers meeting certain requirements. Why Amedisys Amedisys is a leading provider of home health, hospice, and high-acuity care, dedicated to helping patients and families navigate the complex healthcare system. With a focus on compassionate, patient-centered care, you would be joining a team of professionals committed to improving the lives of those they serve. Responsibilities The Project Manager is responsible for initiating, planning and executing various types of initiatives that could include business process improvements and/or technical components <ol> <li>Independently manage strategic projects from the initiation phase through the implementation phase.</li> <li>Work with project leadership on enterprise wide strategic initiatives.</li> <li>Define scope, develop and steward project plans, schedules, budget, and execute project to completion.</li> <li>Lead successful delivery of critical projects with multiple sponsors and virtual project teams.</li> <li>Establish and maintain relationships with project stakeholders/sponsors and serve as a liaison between sponsors, vendors and/or IT.</li> <li>Performs other duties as assigned. </li> </ol> Qualifications Required: <ul> <li>Bachelor's degree in Business, Computer Science or related field; 5 years of related experience can be used in lieu of degree.</li> <li>Three (3+) years' experience in project management.</li> <li>Hands on experience managing project teams including monitoring and reporting status and project risk.</li> <li>Experience with other project management tools can take the place of Microsoft Project.</li> <li>Exposure to Project Management Knowledge Areas: Integration Management, Scope Management, Time Management, Cost Management, Quality Management, Human Resource Management, Communications Management, Risk Management, and Procurement Management.</li> <li>Experience with implementing/interfacing with third party software.</li> </ul> Preferred: <ul><li>Project Management Professional (PMP) certification</li></ul> Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

Amedisys

Project Manager - PMO

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 Customer Service Supervisor (Meritain Health) typically:<ul> <li>Develops, motivates, evaluates, and coaches staff on work procedures, proper call handling, and teamwork to deliver excellent customer service.</li> <li>Maintains a visible presence and is available to staff to answer questions, monitor calls, and give ongoing feedback.</li> <li>Utilizes available incentive programs to reward, recognize, and celebrate team and individual successes.</li> <li>Assesses individual and team performance on a regular basis, and provides candid and timely feedback regarding developmental training needs; includes completion of monthly and annual scorecards.</li> <li>Monitors all performance metrics, such as daily stats and schedule adherence; allocates resources to meet volume and performance demands.</li> <li>Develops and maintains strong collaborative relationships with constituents and internal business partners to maintain excellent lines of communication and share resources to meet common service center objectives.</li> <li>Removes barriers to job performance and ensures regulatory compliance.</li> <li>Attracts, selects, and retains high caliber, diverse talent, able to successfully achieve or exceed business goals. Builds a cohesive team that works well together.</li> <li>Acts as liaison between staff and other areas, including management, communicating workflow results, ideas, and solutions.</li> <li>Proactively analyzes constituent data, identifying trends and issues. Recognizes and acts on the needs to improve the development and delivery of products and services. Clearly identifies what must be accomplished for successful completion of business objectives.</li> <li>Effectively applies and enforces Aetna HR (Human Resources) policies and practices, i.e., FML (Family Medical Leave)/EML (Extended Medical Leave), Attendance, Code of Conduct, Disciplinary Guidelines, etc.</li> <li>All other duties as deemed necessary to the job function.</li> </ul>Required Qualifications<ul> <li>2 years of experience supporting a claim and/or customer service team in a production-based environment.</li> <li>Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).</li> <li>Ability to work five 8-hour shifts from Monday-Friday between 8am-7:30pm EST. </li> </ul>Preferred Qualifications<ul> <li>Acutely organized and able to effectively prioritize daily workload.</li> <li>Previous experience in the healthcare industry.</li> <li>Previous experience with self-funded or fully insured health care, sales, account management, or TPA (Third-Party Administrator) experience. </li> </ul>Education High school diploma or GED.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $102,081.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Customer Service Supervisor (Meritain Health)

Overview Are you looking for a rewarding career? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay $125,000.00 - $150,000.00 Our compensation reflects the cost of labor across several U.S. geographic markets and may vary depending on location, job-related knowledge, skills, and experience. What's in it for you A full benefits package with choice of affordable PPO or HSA medical plans. Paid time off. Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan. Up to $500 in wellness rewards for completing activities during the year. Use these rewards to support your wellbeing with spa services, gym memberships, sports, hobbies, pets and more.* Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program. 401(k) with a company match. Family support with infertility treatment coverage*, adoption reimbursement, paid parental and family caregiver leave. And more. Please note: Benefit eligibility can vary by position depending on shift status. *To participate, you must be enrolled in an Amedisys medical plan. **For full-time caregivers meeting certain requirements. Why Amedisys Amedisys is a leading provider of home health, hospice, and high-acuity care, dedicated to helping patients and families navigate the complex healthcare system. With a focus on compassionate, patient-centered care, you would be joining a team of professionals committed to improving the lives of those they serve. Responsibilities Responsible for initiating, planning and executing various types of strategic initiatives, including business process improvements and technical components. This role will have a specific focus on programs related to automation and Robotics Process Automation (RPA), aligning these efforts with organizational strategy, optimizing processes, and ensuring successful implementation and operationalization. <ul> <li>Aligns with key functional areas within corporate departments, serving as a liaison between process and technology, providing advice on potential solutions to existing gaps and opportunities, and ensuring those solutions fit within the defined/approved architecture.</li> <li>Evaluates current industry standards (process and technology) for project/program delivery in healthcare setting, specifically related to automation.</li> <li>Leverages deep understanding of AI/ML lifecycle, including data collection, model training, evaluation, deployment, and monitoring, to successfully lead automation initiatives as well as support solution design.</li> <li>Uses analytics and gaps analysis to discover opportunities for optimization and automation of key areas in the organization and works with leadership to align, implement and measure properly.</li> <li>Works with department leaders to define and manage value-driven initiatives that are aligned with enterprise strategies.</li> <li>Ensures proper accountability for budgets and success of all projects/programs.</li> <li>Creates a model for succession management by mentoring fellow project managers on project management best practices.</li> <li>May supervise or lead Business System Analyst or Project Manager on multiple projects.</li> <li>Complies with policies, procedures and regulatory mandates including but not limited to abiding to the terms of the Amedisys Compliance Program.</li> <li>Performs other duties as assigned.</li> </ul> Qualifications Required: <ul> <li>Six (6+) years' experience in project management, including two (2+) years directly managing AI/ML, RPA initiatives.</li> <li>Demonstrated project management experience managing end-to-end delivery of AI and Robotics Process Automation (RPA) products.</li> <li>Hands on experience managing project teams including monitoring and reporting status and project risk.</li> <li>Experience with Microsoft Project or other project management applications.</li> <li>Experience with implementing/interfacing with third party software.</li> <li>PMP, PMI-ACP or SAFe certified.</li> </ul> Preferred: <ul> <li>Bachelor's degree in business administration, computers science, healthcare management or related field.</li> <li>Experience with UiPath and PowerAutomate.</li> <li>Previous experience in healthcare or other regulated industry.</li> <li>Six Sigma Black Belt</li> </ul> Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.

Automation Program Manager - PMO

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary The Clinical Operations Advisor is a client facing role that collaborates with Health Plan Clinical Advisor to understand the client’s clinical strategy and roadmap to create a clinical operations plan. The Clinical Operations Advisor works with the Benefit Relationship Manager and client to facilitate gathering formulary and utilization management requirements and designs the drug level setup for projects on the operations plan while ensuring compliance to internal best practice and federal and state guidelines.The Clinical Operations Advisor designs the clinical setups using Caremark technology solutions and supports the coding teams in the loading of clinical data into the adjudication system. The Clinical Operations Advisor partners with account team members to document clinical design best practices, provide input to streamline processes, and identify opportunities to improve the efficiency and accuracy of clinical setups. The Clinical Operations Advisor supports internal and client audits of clinical setups within adjudication systems, which includes verifying the client approved requirements and design.The Clinical Operations Advisor should be able to manage multiple health plan clients across multiple lines of business including Medicare, Medicaid, Exchange, and Commercial. This is a remote role, open to qualified candidates within the Central or Eastern time zones of the United States. Clinical Operations Advisor must have the ability to travel up to 5% of the time. Required Qualifications<ul> <li>Active Registered Pharmacist license in state of residence</li> <li>2-3+ years prior relevant work experience as a pharmacist in managed care (Pharmacy Benefit Management) environment</li> <li>Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics (Medicare, Medicaid, Exchange, and or Commercial) and industry trends</li> <li>Demonstrated experience with Utilization Management and Formulary Management in managed care environment</li> <li>Proficiency with Microsoft applications - Excel, PowerPoint, Word, Outlook, Access, Teams</li> <li>Demonstrated experience with CVSH internal reporting and analytic tools for client management or industry equivalent</li> <li>Excellent written and verbal communication skills both virtually and in person</li> <li>Ability to analyze large volume of clinical data and organize this data for downstream teams such as configuration and testing teams</li> <li>Attention to detail to ensure data fidelity and data integrity is well understood including the business rules for data transformation</li> <li>Ability to work on multiple projects, prioritize, and resolve complex problems</li> <li>Effectively work independently without daily supervision</li> <li>Impact and influence others</li> <li>Drive results and deliver on goals and commitments</li> <li>Facilitate cross functional communication and collaboration</li> <li>Consult and influence internal stakeholders and client contacts</li> </ul> Preferred Qualifications<ul> <li>Experience supporting Pharmacy Benefit Management (PBM) clients or within a health plan</li> <li>Experience in all market segments (Medicare, Medicaid, Exchange and Commercial)</li> <li>Expertise in Utilization Management, Formulary Management and Clinical Products</li> <li>Experience implementing template and/or customized clinical programs</li> <li>Knowledge of PBM adjudication engine and other systems leveraged in support of clients</li> <li>RxClaim experience</li> <li>Proven leadership skills</li> <li>Commitment to client service and relationship building</li> </ul> EducationBachelor Degree in Pharmacy required, PharmD preferredAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$110,925.00 - $249,600.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

15 Operations Jobs in Sterling, VA, USA