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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.Job DescriptionReporting to the SVP, CFO of Pharmacy and Consumer Wellness (PCW), the VP, Segment FP&amp;A - PCW will serve as a trusted advisor to the Pharmacy and Consumer Wellness leadership team in support of the front store and retail pharmacy businesses across the company’s more than 9,000 CVS Pharmacy® locations. This role will lead and develop a team of finance colleagues to optimize partnership with key executives, drive the highest level of analysis and provide actionable insights to aid in strategic and operational decision making. The VP, Segment FP&amp;A, PCW will provide strategic direction to their direct reports and lead all major end-to-end planning, reporting, and capital investment processes across the PCW segment. Through the alignment of priorities, milestones and measurements across PCW, this role will ensure elite execution of business imperatives. Major Responsibilities<ul> <li>Coach and mentor a team of finance professionals, prioritizing their growth and development.</li> <li>Champion an innovative and collaborative environment.</li> <li>Lead the development of the PCW segment’s operating plans and quarterly forecasts. Ensure that plans are integrated and coordinated across business segments, and with enterprise partners.</li> <li>Partner with PCW business strategy lead, CFO and business leaders to build and execute short and long-range strategic plans.</li> <li>Manage and strategically position the management process for the PCW business; navigate process across the enterprise.</li> <li>Accountability for all planning, reporting and business performance management across lines of business.</li> <li>Monitor progress against multi-year strategic, financial and operational metrics and targets.</li> <li>Lead PCW capital investment, forecasting and management process.</li> <li>Lead PCW data, visualization and automation work across the finance team.</li> <li>Develop and execute communications / plans for senior leaders, to summarize business results, business issues, recommended solutions.</li> <li>Act as liaison between respective business executives and other internal and external constituents.</li> <li>Proactively play key role on PCW executive leadership team as “enterprise voice” on PCW/Finance initiatives to ensure that enterprise partners are connecting the dots.</li> <li>Centrally coordinate operational and strategic planning and oversight.</li> <li>Coordinate development and monitor implementation of PCW action plans to seize competitive opportunities and/or respond to performance shortfalls/plan variances.</li> <li>Must have strong relationship-building and collaboration skills, as well as very strong financial acumen.</li> <li>Experience with and ability to act in a leadership capacity across the PCW leadership team—drive management process meetings, capital plan meetings, operating plan meetings, etc.</li> <li>Develop strong relationships across the enterprise to collaborate and effectively represent and balance PCW interests with enterprise goals.</li> </ul>Required Qualifications<ul> <li>20+ years of experience in Healthcare and Finance</li> <li>5+ years of people leader experience</li> <li>Experience at leading execution and delivery (planning, delivering, and supporting)</li> <li>Adept at business intelligence</li> <li>Adept at collaboration and teamwork</li> <li>Strong oral and written communication skills</li> <li>Experience in problem solving and decision-making skills</li> <li>Mastery of growth mindset (agility and developing yourself and others) </li> <li>Open to location but will require regular travel to Rhode Island office</li> <li>Remote will require regular travel to Hartford office</li> </ul>EducationBachelor's degree (required)Master's degree (preferred)The typical pay range for this role is:$220,000.00 - $320,000.00This 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. 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/benefits" target="_blank">jobs.CVSHealth.com/benefits</a>We anticipate the application window for this opening will close on: 05/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through <a href="#">ColleagueRelations@CVSHealth.com</a> If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

CVSHealth

VP, Segment FP&A - Pharmacy and Consumer Wellness

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<ul> <li>Guides development of holistic solutions or strategic plans negotiates and executes contracts with the most complex, market /region/national, largest group/system or highest value/volume of spend providers with significant financial implications.</li> <li>Manages contract performance, and drives the development and implementation of value based contract relationships in support of business strategies.</li> <li>Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.</li> <li>Responsible for identifying and managing cost issues and collaborating cross functionally to execute significant cost saving initiatives. Represents company with high visibility constituents, including customers and community groups. Promotes collaboration with internal partners.</li> <li>Evaluates, helps formulate, and implements the provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.</li> <li>Collaborates with internal partners to assess effectiveness of tactical plan in managing costs. May optimize interaction with assigned providers and internal business partners to facilitate relationships and ensure provider needs are met. Ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.</li> </ul>Required Qualifications<ul> <li>Critical thinking to maintain cost management and a fully engaged network of participating hospitals, ancillaries and providers.</li> <li>A minimum of 5 years related experience and comprehensive level of negotiating skills with successful track record negotiating contracts with hospitals.</li> <li>Understanding knowledge of Value Based Contracting.</li> <li>Microsoft Office/Excel proficient</li> </ul>Preferred Qualifications<ul> <li>Healthcare Industry experience with either a payer or provider</li> <li>Strong communication, critical thinking, problem resolution and interpersonal skills.</li> <li>Internal Aetna system knowledge a plus.</li> <li>Understanding of Medicare &amp; Commercial.</li> <li>Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, financial/contracting arrangements and regulatory requirements.</li> </ul> Education<ul><li>Bachelor’s Degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$75,400.00 - $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. 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: 05/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Provider Network Contracting (MA/RI)

Salary Range $188,000 - $245,000*Job Description:Role Summary:As the AVP of Brand Strategy, you will be responsible for shaping and executing the overarching brand vision, purpose, and positioning for Saks, Neiman Marcus, and Bergdorf Goodman. You will play a critical leadership role in ensuring that the brand strategies for each of these iconic luxury retailers remain aligned with market trends, customer expectations, and business goals. Leading a team of two (Director and Senior Manager), you will drive the development and implementation of strategic initiatives that elevate each brand's presence in the luxury retail sector. This role reports directly to the senior-most leader of Portfolio &amp; Brand Strategy and works closely with cross-functional teams across marketing, merchandising, stores and executive leadership.Role Description:Brand Vision, Purpose &amp; Positioning:<ul> <li>Lead the development and evolution of the brand vision, purpose, and positioning for Saks, Neiman Marcus, and Bergdorf Goodman, ensuring they resonate with the brands' respective target audiences while staying true to their heritage and values.</li> <li>Collaborate with senior leadership to refine and communicate the strategic direction for each brand, ensuring alignment across internal teams and external communications.</li> <li>Ensure that brand positioning is consistently reflected across all consumer touchpoints, including marketing campaigns, store environments, digital experiences, and customer service interactions.</li> </ul>Brand Strategy Leadership:<ul> <li>Develop and implement brand strategies that drive growth, customer loyalty, and market differentiation for Saks, Neiman Marcus, and Bergdorf Goodman.</li> <li>Oversee the creation of integrated, multi-channel marketing plans that align with each brand’s unique identity and objectives.</li> <li>Collaborate with key stakeholders across marketing, merchandising, digital, and creative teams to ensure alignment and integration of brand strategy across all touchpoints and initiatives.</li> </ul>Team Leadership &amp; Development:<ul> <li>Lead, mentor, and develop a team of two Senior Managers, providing strategic guidance, support, and professional development to help them succeed in driving brand strategy for Saks, Neiman Marcus, and Bergdorf Goodman.</li> <li>Foster a culture of collaboration, creativity, and results-driven thinking within the team, ensuring high performance and alignment with broader business objectives.</li> <li>Ensure clear communication and feedback loops within the team and with senior leadership to track progress and adjust strategies as needed.</li> </ul>Strategic Brand Initiatives:<ul> <li>Identify and drive key brand initiatives that will enhance each brand’s position in the market and increase customer engagement and loyalty.</li> <li>Work cross-functionally to develop strategic programs that support brand growth, including seasonal campaigns, influencer partnerships, limited-edition collaborations, and new customer experiences.</li> <li>Develop and execute competitive brand audits to identify opportunities for innovation and market leadership.</li> </ul>Market &amp; Consumer Insights:<ul> <li>Lead the development of consumer and market insights to inform brand strategy and ensure the brands are positioned to meet evolving customer needs.</li> <li>Utilize data-driven insights to optimize brand positioning, messaging, and product offerings. Stay ahead of trends and shifts in the luxury retail market, continuously refining brand strategy to maintain relevance and drive growth.</li> </ul>Cross-Functional Collaboration:<ul> <li>Partner with senior leaders across Saks, Neiman Marcus, and Bergdorf Goodman to ensure that brand strategy is seamlessly integrated into the overall business plan.</li> <li>Work closely with the marketing, merchandising, creative, and digital teams to ensure brand strategies are executed effectively and consistently.</li> <li>Lead brand-focused cross-functional teams to deliver on key strategic initiatives that drive brand awareness, customer engagement, and business performance.</li> </ul>Measurement &amp; Reporting:<ul> <li>Develop and implement brand performance metrics to measure the success of brand strategies and initiatives.</li> <li>Report on brand health, customer perception, and performance across key touchpoints to senior leadership, providing insights and recommendations for refinement.</li> <li>Ensure continuous tracking and reporting on the effectiveness of brand campaigns, making adjustments where necessary to optimize impact.</li> </ul>Required Qualifications (Minimum Requirements):<ul> <li>Bachelor’s degree in Marketing, Business, or a related field; MBA or advanced degree preferred.</li> <li>8+ years of experience in brand strategy, marketing, or a related field, with significant experience in luxury retail or fashion.</li> <li>Proven track record of developing and executing successful brand strategies across multiple consumer touchpoints.</li> <li>Experience leading and managing teams, with strong leadership, mentoring, and team-building skills.</li> <li>Strong analytical skills, with the ability to translate consumer insights and market data into actionable brand strategies.</li> <li>Excellent communication, presentation, and interpersonal skills, with the ability to influence and collaborate with senior leadership and cross-functional teams.</li> <li>Deep understanding of luxury retail brands and consumer behavior, with a passion for staying ahead of industry trends.</li> <li>Ability to manage multiple projects simultaneously and thrive in a fast-paced, dynamic environment.</li> </ul>Your Life and Career at Saks Global: <ul> <li>Exposure to rewarding career advancement opportunities</li> <li>A culture that promotes a healthy, fulfilling work/life balance </li> <li>Benefits package for all eligible full-time employees (including medical, vision and dental). </li> <li>An amazing employee discount </li> </ul>Thank you for your interest in Saks Global. We look forward to reviewing your application.Saks Global provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Saks Global complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.Saks.com is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. *The above expected salary range may have some variability based upon factors including, but not limited to, a candidate’s overall experience, qualifications, and geographic location. If you are interested in the role, we encourage you to apply and, if selected to move forward in the interview process, you will have a chance to speak with our recruitment team regarding your specific salary expectations.

Saks Fifth Avenue

AVP, Brand Strategy

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.POSITION SUMMARY: As an Oncology RPh Advisor in Government Services you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for ensuring cases are accurately set up for our members, review clinical information for decisioning the request, performing outreach to providers for more information when needed, and ensuring accurate decisions that comply with compendia and Medicare guidance and timelines. In addition, as an Oncology Pharmacist you will assist front-line colleagues (i.e. Staff Pharmacists and Representatives) with oncology process/procedural support by acting as a subject matter expert and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education, continuing education and certification. This position also supports departmental leadership in identifying issues, concerns and trends within the workflow process. The Pharmacist will partner with our Lead Oncology Pharmacist to help develop/deliver formal clinical training sessions, delivering them to staff to enhance their clinical knowledge base in relation to the oncology disease states and therapies. Strong effective communication is required to ensure the thorough distribution, understanding and execution of required knowledge transfer to internal and external stakeholders. The Pharmacist will be expected to work closely with other teams and departments throughout the company including Case Review Unit (CRU), Commercial PA &amp; appeals, internal Medical Directors, Clinical Development, and our Client Liaison team. This is a work-from-home role open to qualified candidates within the United States. Candidate must be willing and able to work 9am-5:30pm EST M-F, with the ability to flex to later or earlier if needed for training, client meetings, or other business needs. PRIMARY DUTIES AND RESPONSIBILITIES: 1. Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design with a focus on oncology reviews. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval &amp; denial management processes. % Time: 70% 2. A Leader in identifying and solving issues, concerns and trends within the workflow process that need to be addressed at a higher level resulting in optimal performance and outcomes. Responsible for assisting front-line colleagues (i.e. Staff Pharmacists and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. % Time: 20% 3. Assist with standard or client specific oncology review process changes as needed. % Time: 5% 4. Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients. % Time: 5%EDUCATIONBS in Pharmacy or PharmDRequired: Licensed Pharmacist and Board Certified Oncology Pharmacist (BCOP) REQUIRED SKILLS &amp; OTHER MINIMUM REQUIRED QUALIFICATIONS: • Active pharmacist license in the state of residence that is in good standing.• Board Certified Oncology Pharmacist (BCOP) required • 2+ years clinical pharmacist experience, inclusive of prior authorization experience• Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential. • Must be able to multitask and utilize multiple system applications simultaneously. • Must be able to utilize available resources independently and provide high quality work. • Must demonstrate problem solving ability and attention to detail. • Demonstrated clinical expertise in the oncology therapy arena, with recent career focus in the oncology area. • Ability to adapt and change with workflow and shifting priorities. • Ability to work effectively in a team environment and provide mentorship to front line staff on the PA team. • Must possess excellent written, verbal, grammar, and listening communication skills. • Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner. • Ability to maintain confidentiality of PHI (Protected Health Information). ESSENTIAL FUNCTIONS: 1. Regular and predictable attendance. 2. Colleague will be required to work mandatory overtime/extended work week when needed. 3. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.4. Adhere to all policies and procedures. 5. Attend on-going training and development meetings. Physical Requirements: 1. Sits at desk for long periods of time. 2. Talking on phone for extended periods of time. 3. Computer use for extended periods of time. 4. Reading a computer screen. WORK ENVIRONMENT: Work from an approved work-from-home location.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$45.43 - $101.54This 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: 05/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Clinical Pharmacist - Coverage Determinations/Oncology (BCOP Required)

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.Sr. Manager, Clinical AssumptionsPosition Summary:As Sr. Manager, Clinical Assumptions, you will join the Pharmaceutical Forecasting and Analysis team supporting the unified PBM Connected Ecosystem to drive accountability and accuracy across the Caremark Organization. The Sr. Manager, Clinical Assumptions will play a key role in developing, supporting and maintaining PBM Assumptions. In this role you will act as a subject material expert in the Clinical field driving accuracy in financial modeling of the Underwriting Ecosystem by connecting with Business Process Owners and Data Architects to emulate future member behavior with the financial modeling. Primary responsibilities include coordinating with Formulary Management to stay abreast of upcoming strategic changes and decode their financial impact, drive accurate modeling by providing clinical guidance when needed on therapeutic equivalencies or interchangeability, and act as a representative of the Client Financial Analysis and Optimization (CFAO) organization with Trade &amp; Medical Affairs as needed.Additionally, this position will:<ul> <li>Partner with Business resources to gather, refine and evaluate new clinical assumptions that influence the business.</li> <li>Foster strong relationships within the PBM Ecosystem to elevate accurate financial stewardship as it related to clinical assumptions.</li> <li>Support discussions that are highly complex.</li> <li>Drive results utilizing durable and automation focused solutions.</li> <li>Prioritize effectively and efficiently to meet internal and external customer needs.</li> <li>Support the translation market dynamics to usable business intelligence.</li> <li>Participate in peer reviews of high complex data requests to validate that modeled data and related analytic deliverables match and satisfy business requirements.</li> <li>Assist in ad-hoc analysis</li> </ul>The successful candidate will have a track record that demonstrates the following abilities: working successfully in a cross-matrix environment, adapting and performing in a dynamic and changing environment, developing and leveraging a comprehensive understanding of CVS Caremark’s enterprise assets, developing a deep understanding of internal and external assumptions, maintaining high levels of customer satisfaction, constantly striving to innovate and improve processes and applying financial and analytical expertise to make informed recommendations and decisions.Required Qualifications:<ul> <li>7+ years professional clinical and/or financials experience, preferably within a PBM or health plan</li> <li>1+ years experience working with health plans, employer clients, or coalitions/TPAs, with multiple lines of business with different funding arrangements.</li> <li>Able to travel up to 10% of the time.</li> </ul>Preferred Qualifications:<ul> <li>Expertise in Utilization Management and Formulary Management.</li> <li>Knowledge and experience with Microsoft applications (Excel, Power Point, Word, Outlook, Teams).</li> <li>Strong understanding of, or experience with, internal and external facing pricing and analytics teams.</li> <li>Ability to innovate, develop, and implement new products or solutions requiring collaboration with internal partners. Demonstrated success developing effective relationships with key internal partners across the enterprise.</li> <li>Knowledge of relational databases and warehouses, advanced SQL, VBA, OLAP and SAS skills.</li> <li>Experience managing complex projects in a matrix environment.</li> <li>Ability to summarize complex pharmaceutical findings and support recommendations in presentations to Executive Leadership.</li> <li>Ability to work independently in a fast-paced environment and manage tight deadlines.</li> <li>AMCP Fundamentals of Managed Care Pharmacy Certificate or similar professional advancement.</li> <li>Previous PBM Pricing, Underwriting, Data analytics or Financial Analysis experience</li> </ul>Education:<ul> <li>BS Pharmacy or PharmD</li> <li>Licensed Pharmacist</li> </ul>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: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Manager, Clinical Assumptions

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 Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems.Additional Responsibilities: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.- Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.- Ensures all compliance requirements are satisfied and all payments are made against company practices and procedures.- Identifies and reports possible claim overpayments, underpayments and any other irregularities.- Performs claim rework calculations.- Distributes work assignment daily to junior staff.- Trains and mentors claim benefit specialists.- Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- 18+ months of medical claim processing experience.- Experience in a production environment.- Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $42.35This 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: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Claim Benefit Specialist

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 SummaryBring 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 SummaryHealth Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.<ul> <li>Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.</li> <li>Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.</li> <li>Fully understands the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.</li> <li>Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.</li> <li>Uses customer service threshold framework to make financial decisions to resolve member issues.</li> <li>Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).</li> <li>Utilizes all relevant information to effectively influence member engagement.</li> <li>Takes immediate action when confronted with a problem or made aware of a situation.</li> <li>Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.</li> <li>Identifies member needs beyond the initial inquiry by answering the unasked questions.</li> <li>Resolves issues without or with limited management intervention.</li> <li>Provides education to members to support them in managing their health.</li> <li>Responds quickly to meet customer needs and resolve problems while avoiding over-committing.</li> <li>Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.</li> <li>Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.</li> <li>Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.</li> <li>Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.</li> <li>Partners with other departments to deliver client specific presentations.</li> <li>Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.</li> <li>Works collaboratively with colleagues to deliver the best customer experience Seeks to understand the customer, including circumstances, problems, expectations and needs.</li> <li>Asks probing questions to identify the underlying customer needs.</li> <li>Appropriately transitions conversations to explore possibilities for extending customer interactions.</li> <li>Guides members to the appropriate health resource Offers alternatives where appropriate.</li> <li>Acts with the best interest of customer in mind and central to all interactions.</li> <li>Collaborates with colleagues and co-workers to deliver a world class customer experience.</li> <li>Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.</li> <li>May participate in preparation and presentation of client specific presentations.</li> <li>May track and trend data.</li> <li>Coaches, trains and assists in the development of call center staff, as required.</li> <li>Participates in and/or leads special projects/initiatives addressing service issues, as necessary.</li> <li>Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.</li> <li>Delivers internal quality reviews.</li> <li>Provides appropriate support in third party audits when required.</li> <li>Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.</li> </ul> Required Qualifications<ul> <li>Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.</li> <li>Effective organizational skills and ability to manage multiple tasks.</li> <li>Effective communication skills, both verbal and written</li> <li>Experience working with computers Education High School Diploma </li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $25.65This 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: 05/06/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Health Concierge

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 Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. This position may support UM, MPO, Coding, or Behavioral Health appeals. Required Qualifications • Must have active and unrestricted RN licensure in state of residence • 3+ years clinical experience Preferred Qualifications• Appeals Experience • Managed Care Experience • Utilization review experience • Proficiency with computer skills including navigating multiple systems • Exceptional communication skills. • Time efficient, highly organized, and ability to multitask Education • Associate's Degree minimumAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$66,575.00 - $142,576.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Appeals Nurse 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 Summary We are seeking a highly skilled and experienced Security Engineer to join our Secure Collaboration Team. The successful candidate will be responsible for maintaining and enforcing security policies for various collaboration platforms, including SharePoint, OneDrive, Teams, Slack, SFTP, eShare, and related capabilities. This role will play a critical part in ensuring the security and compliance of these platforms while supporting the organization's overall secure sharing strategy.Primary Job Duties &amp; Responsibilities<ul> <li>Develop, implement, and maintain security policies for collaboration platforms, like M365, Teams, Slack, and SFTP, ensuring alignment with corporate security standards and regulatory compliance requirements.</li> <li>Oversee user access controls, identity management, and permission policies for collaboration platforms to ensure the least privilege access model.</li> <li>Conduct regular risk assessments and vulnerability assessments for collaboration platforms and implement necessary risk mitigation controls.</li> <li>Work with internal teams to integrate collaboration platforms into the enterprise security infrastructure, ensuring secure configuration and setup.</li> <li>Educate employees on best practices for secure usage of collaboration platforms, promoting a culture of security awareness within the organization.</li> <li>Work closely with IT, compliance, and business teams to ensure security requirements are met and any security concerns are addressed promptly.</li> <li>Develop and maintain collaboration dashboards and KPI reports in PowerBI to continuously monitor usage and trends of various collaboration platforms.</li> <li>Track and report usage of unsanctioned file sharing tools and cloud storages, support documentation of security incidents, response actions, and lessons learned.</li> <li>Stay up to date with security features and tools available for platforms like M365, Teams, eShare, Slack, and SFTP, and leverage them to enhance platform security.</li> <li>Create and maintain Azure Runbooks using PowerShell scripts, and automation using PowerApps.</li> <li>Continuously drive a simplified, consistent user experience at points of service engagement.</li> </ul>Required Qualifications<ul> <li>5+ years of experience in a security engineering or administration of collaboration platforms such as SharePoint, OneDrive, Teams, Slack, and cloud sharing tools.</li> <li>3+ years of experience with data at rest and data in motion encryption and other data protection techniques in cloud environments.</li> <li>2+ year of experience with automation of apps utilizing PowerApp.</li> <li>2+ year of experience in cloud sharing security configuration of M365 services and Azure.</li> <li>2+ year of experience with PowerBI and Azure Runbooks using Powershell.</li> </ul> Preferred Qualifications<ul> <li>Experience with eShare collaboration platform.</li> <li>Experience with secure file access and transfer protocols (SFTP).</li> <li>Excellent problem-solving skills and ability to work independently and collaboratively in a fast-paced environment.</li> <li>Strong communication skills to articulate security risks, solutions, and best practices to non-technical stakeholders.</li> <li>Demonstrated experience working with a wide range of internal and external stakeholders at all levels on strategic and operational information security programs.</li> <li>Strong analytical skills and the ability to understand and solve complex problems</li> <li>Experience in documenting and implementing procedures and guidelines.</li> <li>Continuous learner well informed on technology trends, tools, methodologies, and models.</li> <li>Ability to manage a high degree of complexity and distill information that provides clear direction.</li> <li>Comfortable operating within areas of ambiguity to iterate and make progress in a consistent manner.</li> <li>Agility to deal with a constantly changing business environments.</li> </ul> Education<ul><li>Bachelor’s degree or equivalent experience (High School Diploma and 4 years relevant experience)</li></ul>BUSINESS OVERVIEWBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunitiesAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$101,970.00 - $203,940.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Security Engineer - Secure Collaboration

Thriveworks Counseling is seeking individuals pursuing Massachusetts State Licensure as a LICSW in Massachusetts. ***For a limited time, we are offering a $5,000 SIGN ON BONUS!***Thriveworks is a clinician-founded national private practice group with locations in 48 states. Our mission is to help people live happy, successful lives, and we believe that client accessibility, integrity, and quality care are what is most important. We put a lot of emphasis on the thought that—for our clinical team to be accessible to clients—we must fully support our clinicians by allowing them to do what they are trained to do. We operate under the idea that we are most successful by focusing on one job and being great at that job. Qualifications:<ul> <li>A graduate of an approved 60-credit hour Master's program</li> <li>Graduate or post-graduate work experience in a counseling setting treating depression and anxiety required.</li> <li>Graduate or post-graduate work experience independently conducting intakes and diagnosing according to the current DSM under a licensed supervisor.</li> </ul>What We Need:<ul> <li>Full-time availability (30 hours/week – 25 client visits with 5 hours administrative time including supervisory meetings).</li> <li>Flexibility in your work schedule </li> </ul>What We Give:<ul> <li>FREE group and individual clinical supervision provided</li> <li>A W2 employment model with guaranteed pay including paid orientation, no show protection, annual pay increases and additional bonus opportunities.</li> <li>Flexibility with scheduling - we’re open 7am-10pm (seven days a week)</li> <li>Full clinical caseload typically established within the first 30 - 45 days.</li> <li>Benefits that include group health. Dental and vision, disability, life, and liability insurance options, 401K program with a 3% employer match, malpractice insurance and PTO.</li> <li>Amazing team culture and clinical support with monthly in-house professional development, career advancement opportunities, autonomy, but with access to case consultation groups.</li> <li>No required on-call</li> <li>Support team for scheduling, billing, client services, and customized marketing</li> </ul>Compensation: This is a Fee for Service position, earning potential is $55,000 - $65,000 (could vary based on # of sessions and bonus opportunities). Your recruiter will discuss total compensation during the interview. A career at Thriveworks isn’t just about finding a job that pays the bills. It’s about helping others, joining a community, and learning to thrive both personally and professionally. We believe that the success of our employees is just as important as the success of our organization — in fact, they go hand in hand.So, what do you say? Are you interested in joining our team? Apply today.#LI-Remote #LI-MS1Interested in joining Team Thriveworks? We're thrilled to meet you!With Job scams becoming more and more frequent, here's how to know you're speaking with a real member of our team:<ul> <li>Our recruiters and other team members will only email you from <a href="mailto:thriveworks@myworkday.com" target="_blank">thriveworks@myworkday.com</a> or an @thriveworks.com email address.</li> <li>Our interviews will take place over Google Meet (not Microsoft Teams or Zoom)</li> <li>We will never ask you to purchase or send us equipment.</li> </ul>If you see a scam related to Thriveworks, please report to <a href="mailto:infosec@thriveworks.com" target="_blank">infosec@thriveworks.com</a>. You can contact <a href="#">employment@thriveworks.com</a> with any questions or concerns.Thriveworks is an Equal Opportunity Employer. Our people are our most valuable assets. We embrace and encourage differences in age, color, disability, ethnicity, gender identity or expression, national origin, physical and mental ability, race, religion, sexual orientation, veteran status, and other characteristics that make our employees unique. We encourage and welcome diverse candidates to apply for any position you are qualified for to bring your unique perspective to our team.By clicking Apply, you acknowledge that Thriveworks may contact you regarding your application.

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