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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 Leverages technology and data to improve healthcare outcomes by designing, implementing, and maintaining health information systems, analyzing healthcare data, and utilizing technology to support clinical workflows and decision-making. Applies expertise in healthcare and information technology to ensure efficient data management, promote data-driven insights, and enhance the delivery of healthcare services.What you will do<ul><li>Produces customized reports of varied healthcare data to assist in the assessment of health and economic outcomes.</li></ul><ul> <li>Collects, organizes, and analyzes healthcare data from various sources, such as relational databases and claims data.</li> <li>Employs statistical methods and data visualization techniques to identify trends, patterns and gaps in care that can support sales and operations.</li> <li>Creates interactive dashboards and reports utilizing Tableau desktop and Tableau Server</li> <li>Collaborates with business partners to identify data requirements, extract data from multiple sources and present findings.</li> <li>Verifies accuracy of data using multiple methods, including SQL queries; motivated to explore multiple avenues of data irregularities and identify the cause.</li> <li>Documents methods, specifications, and findings clearly.</li> <li>Identifies opportunities for process improvement by leveraging data analysis to identify bottlenecks, inefficiencies, and areas for automation.</li> <li>Juggles multiple deliverables and timelines and completes assigned projects accurately and on-time.</li> <li>Makes positive contributions to a motivated work environment by working collaboratively and efficiently with other team members to achieve common goals.</li> </ul> Required Qualifications<ul> <li>5+ years of data analysis experience and expert with Tableau.</li> <li>5+ years of computer skills and knowledge of Microsoft Word, Excel, PowerPoint, Access.</li> </ul> Preferred Qualifications<ul> <li>5+ years of SQL experience</li> <li>3+ year(s) of managed care experience</li> <li>Strong analytic skills with ability to interpret trends and outliers and translate insights into recommendations.</li> <li>Adept at probing into granular details of big data and complex technical processes.</li> <li>Strong written and verbal communications skills to convey complex data insights to a diverse audience.</li> <li>Ability to perform root-cause analysis.</li> <li>Strong collaboration and communication skills within and across teams.</li> <li>Ability to work in a fast-paced environment and meet tight deadlines.</li> <li>Strong team player with ability to encourage teamwork and a positive environment.</li> <li>Ability to be resourceful and quickly adapt to changing business requirements.</li> <li>Attention to detail.</li> </ul> Education<ul><li>Bachelor’s degree in a related field (e.g., Analytics, Informatics) and/or equivalent work experience.</li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Mgr, Informatics

You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Act as an advocate for members and a liaison between the Health Plan and Provider(s) to ensure availability and access to care. Establish a community presence, promote member education, identify and resolve any systemic barriers that limit access to appropriate care.<ul> <li>Receive and respond to member complaints and formal grievances and identify potential access barriers and resolve as indicated in the grievance procedure.</li> <li>Serve as primary contact and liaison between member advocacy groups, human services agencies, providers and State entities.</li> <li>Evaluate member qualifications for better benefit entitlement programs.</li> <li>Conduct field trainings and face-to-face meetings with providers, members and community agencies and report results to senior management for any needed resolutions.</li> <li>Recommend changes in internal processes to affect provider and member satisfaction.</li> <li>Advise Health Plan on contract compliance in the delivery of covered services.</li> <li>Perform training, orientation and coaching for performance improvement within physician practices, community agencies, and health plan.</li> <li>Educate members and providers regarding policies and procedures related to benefits, website promotion and education.</li> <li>Investigate and resolve access and cultural sensitivity issues identified by internal departments, State staff, providers, advocacy organizations and members.</li> <li>Participate in local community coalitions to acquire knowledge and insight regarding the special health care needs of members and update and revise educational materials as appropriate.</li> <li>Must have a good driving record and the ability to travel.</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Associate’s degree or equivalent experience. 3+ years of public relations experience. Experience in working with diverse populations. Knowledge of health care, managed care, Medicare or Medicaid. Claims billing/coding knowledge preferred. License/Certification: Valid driver’s license. Insurance producer license preferred.Pay Range: $22.79 - $38.84 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Oklahoma Complete Health

Member Advocate II

About Lumen Lumen connects the world. We are igniting business growth by connecting people, data and applications – quickly, securely, and effortlessly. Together, we are building a culture and company from the people up – committed to teamwork, trust and transparency. People power progress. We’re looking for top-tier talent and offer the flexibility you need to thrive and deliver lasting impact. Join us as we digitally connect the world and shape the future. <h2>The Role</h2> Sr. Planning Engineer is a remote-based full-time position, individual contributor who is part of the Lumen Mass Markets. This is a strong, self-motivated individual with the ability to communicate professionally in a dynamic and fast paced environment while maintaining the highest level of integrity and quality in their work. <h2>Work Location</h2> This position has been designated as fully remote in the U.S. <h2>The Main Responsibilities</h2> <ul> <li>Complete GIS high level designs for Lumen’s 500,000+ fiber to the unit build.</li> <li>GIS and high-level design SME for other high-level designers.</li> <li>Provide continual feedback to GIS support team on system enhancements relative to high level design package/process improvements.</li> </ul> <h2>What We Look For in a Candidate</h2> <ul> <li>Bachelor's Degree in GIS, Engineering, Computer Science, or relevant experience.</li> <li>3-5+ years in direct GIS Analyst experience.</li> <li>Experience utilizing mapping tools such as ESRI ArcGIS.</li> <li>2-3+ years planning OSP, ISP and PON network.</li> <li>3GIS and ESRI direct experience.</li> <li>Knowledge of Outside Plant Copper and Fiber Optic Cable (UG, Aerial, Buried) and manhole and conduit design.</li> <li>High level of proficiency with Microsoft Excel or equivalent program.</li> <li>Work independently with little or no oversight, be able to self-manage their workload and deliver all projects to meet deadlines.</li> <li>Strong documentation writing and analytical skills with high level attention to detail.</li> <li>Must be highly adept at collaborating with others, at all levels in the organization.</li> <li>Experience with Metro/Ethernet network a plus.</li> </ul> <h2>Compensation</h2> This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Individual pay is based on skills, experience and other relevant factors. Location Based Pay Ranges: $82,969.00 - $110,625.00 in these states: AL, AR, AZ, FL, GA, IA, ID, IN, KS, KY, LA, ME, MO, MS, MT, ND, NE, NM, OH, OK, PA, SC, SD, TN, UT, VT, WI, WV, and WY. $87,117.00 - $116,156.00 in these states: CO, HI, MI, MN, NC, NH, NV, OR, and RI. $91,266.00 - $121,688.00 in these states: AK, CA, CT, DC, DE, IL, MA, MD, NJ, NY, TX, VA, and WA. Lumen offers a comprehensive package featuring a broad range of Health, Life, Voluntary Lifestyle benefits and other perks that enhance your physical, mental, emotional and financial wellbeing. We're able to answer any additional questions you may have about our bonus structure (short-term incentives, long-term incentives and/or sales compensation) as you move through the selection process. Learn more about Lumen's: <ul> <li><a href="https://jobs.lumen.com/global/en/benefits-statement" target="_blank">Benefits*</a></li> <li><a href="https://jobs.lumen.com/global/en/compensation-information" target="_blank">Bonus Structure</a></li> </ul> <h2>What to Expect Next</h2> Based on your job application information you may be given the opportunity to complete a video interview immediately after applying. This will include a set of questions for you to record a response to in addition to Game Challenges. Completion of this video interview is a requirement in order to be considered for our open position. Now not a good time? No worries, we will also send you an email with a link to complete the video interview. We strongly recommend that you complete this within 5 days of your application date. Requisition #: 337088 Background Screening If you are selected for a position, there will be a background screen, which may include checks for criminal records and/or motor vehicle reports and/or drug screening, depending on the position requirements. For more information on these checks, please refer to the Post Offer section of our <a href="https://jobs.lumen.com/global/en/faq" target="_blank">FAQ page</a>. Job-related concerns identified during the background screening may disqualify you from the new position or your current role. Background results will be evaluated on a case-by-case basis. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Equal Employment Opportunities We are committed to providing equal employment opportunities to all persons regardless of race, color, ancestry, citizenship, national origin, religion, veteran status, disability, genetic characteristic or information, age, gender, sexual orientation, gender identity, gender expression, marital status, family status, pregnancy, or other legally protected status (collectively, “protected statuses”). We do not tolerate unlawful discrimination in any employment decisions, including recruiting, hiring, compensation, promotion, benefits, discipline, termination, job assignments or training. Disclaimer The job responsibilities described above indicate the general nature and level of work performed by employees within this classification. It is not intended to include a comprehensive inventory of all duties and responsibilities for this job. Job duties and responsibilities are subject to change based on evolving business needs and conditions. In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information. Please be advised that Lumen does not require any form of payment from job applicants during the recruitment process. All legitimate job openings will be posted on our official website or communicated through official company email addresses. If you encounter any job offers that request payment in exchange for employment at Lumen, they are not for employment with us, but may relate to another company with a similar name. Application Deadline 03/07/2025

CenturyLink

Senior Planning Engineer

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 Description Primary Job Duties &amp; Responsibilities: Follows management-established procedures to execute routine business support tasks for core Inbound and Outbound communications functions, under general supervision. Develops effective relationships with all team members to effectively progress daily communications to resolve issues and prevent delays in service or responses. Handles Inbound and Outbound tasks in a manner that operates in full compliance with patient confidentiality policies and regulations. Maintains accurate and complete documentation of member health information to minimize risk management, while adhering to all regulatory, and accreditation requirements. Reviews requests for appropriate referral to medical services staff and approves services that do not require a medical review. Escalates more complex customer/member inbound inquiries to management for more thorough follow-up and resolution. Takes management direction to properly execute techniques, processes, and responsibilities according to established work area policies and procedures. Documents all Inbound and Outbound phone details into the company database to ensure full collection of customer/patient needs and requirements. Demonstrates active listening skills while handling customer/patient calls, also exerting compassion and understanding to gain customer/patient trust and loyalty. Education: -High school diploma or up to 1 year equivalent experience.-Prior Relevant Work Experience -0-1 yearEssential Qualifications: -Working knowledge of problem solving and decision making skills Available Shift: -Shift Available: Sunday- Thursday- 6:30am- 2:30pm EST -Training: 10:00 AM - 6:30 PM EST for first 8 weeks *Some Holidays required*Position Summary Inbound Queue Associate - Behavioral Health role is responsible for accepting inbound calls from facilities, providers, and members regarding pre-certification process within Medicare and Commercial Insurance. Responsibilities to include but limited to the following: • Performs intake of calls from members or providers regarding services via telephone, fax, EDI. • Screens requests for appropriate referral to medical services staff. • Approve services that do not require a medical review in accordance with the benefit plan. • Performs non-medical research including eligibility verification, COB, and benefits verification. • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. • Protects the confidentiality of member information and adheres to company policies regarding confidentiality • Communicate with Aetna Case Managers, when processing transactions for members active in this program • Other duties and responsibilities as required.Required Qualifications • 2 plus years of Customer Service Background • 2 plus years of Call Center experience Preferred Qualifications • Familiarity with basic medical terminology and concepts used in care management. • 2-4 years experience as a medical assistant, office assistant or other clinical experience. • Effective communication, telephonic and organization skills. • Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members. • Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. • Ability to effectively participate in a multi-disciplinary team including internal and external participants Education High School Diploma or equivalent GEDAnticipated 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Behavioral Health Inbound/Outbound Que Associate

About Lumen Lumen connects the world. We are igniting business growth by connecting people, data and applications – quickly, securely, and effortlessly. Together, we are building a culture and company from the people up – committed to teamwork, trust and transparency. People power progress. We’re looking for top-tier talent and offer the flexibility you need to thrive and deliver lasting impact. Join us as we digitally connect the world and shape the future. <h2>The Role</h2> As a Lead CX Executive Escalation Manager, you will play a vital role in ensuring satisfaction and overall experience for Lumen Hypercare escalations. You will be responsible for managing and resolving escalated user inquiries and issues across multiple channels, while also collaborating closely with cross-functional teams to optimize a timely resolution. This is a customer-facing role. Case resolution will be at the forefront of this role, along with strict adherence to activity metrics to ensure alignment with Customer Experience objectives. Lumen strives to be best-in-class, and our team is committed to wholeheartedly embracing this goal. <h2>The Main Responsibilities</h2> <ul> <li>Collaborate with cross-functional teams to resolve escalated issues which are often complex in nature </li> <li>Develop comprehensive action plans and solutions to address identified root causes, considering cost, risk, and resource availability </li> <li>Develop strong partnerships and liaison with sales, customer success, keyers, order managers, provisioners, installation, billing and repair/construction teams to implement strategies and execute tasks </li> <li>Identify opportunities to enhance problem management processes and procedures and recommend and implement process improvements </li> <li>Gather and analyze customer feedback to identify gaps in customer experience, then recommend and implement strategies to improve customer experience metrics </li> <li>Create and present executive level presentations that communicate the impact of implemented solutions and the expected benefits </li> <li>Lead ad hoc project(s) as required related to case resolutions </li> <li>Develop and modify job aids to be used by cross-functional teams </li> <li>Maintain comprehensive documentation on all correspondence in cases, tickets, etc. to include creating timelines, agendas and post-mortem written reports </li> <li>Coach and mentor less experienced team members </li> </ul> <h2>What We Look For in a Candidate</h2> <ul> <li>Education level: BS/BA or equivalent education and experience in Telecommunications or Technology. </li> <li>Experience: 7-10+ years of customer support and demonstrated experience managing large and complex projects across teams or organizations. </li> <li>Excellent communication and effective interpersonal skills in responding concisely, and professionally with the ability to de-escalate difficult situations in a high-pressure environment. </li> <li>Ability to think strategically and operate tactically to provide business insights and achieve operational goals </li> <li>Proven experience in building relationships and experience interfacing at various organizational levels, including VP/SVP </li> <li>Highly organized with strong follow-through abilities and a high level of accuracy for attention to detail with good organizational capabilities. </li> <li>Technical aptitude to understand Lumen product dynamics, services, strategy, and decision-making processes, with acumen to recommend product enhancements. </li> <li>Outstanding communications skills for concise and professional interactions up, down and across the organization. Ability to create clarity and drive focus in complex and dynamic contexts. </li> <li>Ability to manage multiple high-level priorities. </li> <li>Self-motivated, results-driven individual </li> <li>Experience with MS Office Suite, Salesforce, Lumen internal billing platforms </li> <li>Prefer higher than Six Sigma Yellow belt </li> </ul> Preferred <ul> <li>Experience utilizing AI tools to improve efficiency with reporting, data analysis and communications is a plus </li> <li>Ability to quickly learn various software, web-based platforms, and systems in accessing data. </li> <li>Certification in customer service or related fields is a plus. </li> </ul> <h2>Compensation</h2> This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Individual pay is based on skills, experience and other relevant factors. Location Based Pay Ranges $82,969 - $110,625 in these states: AL AR AZ FL GA IA ID IN KS KY LA ME MO MS MT ND NE NM OH OK PA SC SD TN UT VT WI WV WY $87,117 - $116,156 in these states: CO HI MI MN NC NH NV OR RI $91,266 - $121,688 in these states: AK CA CT DC DE IL MA MD NJ NY TX VA WA Lumen offers a comprehensive package featuring a broad range of Health, Life, Voluntary Lifestyle benefits and other perks that enhance your physical, mental, emotional and financial wellbeing. We're able to answer any additional questions you may have about our bonus structure (short-term incentives, long-term incentives and/or sales compensation) as you move through the selection process. Learn more about Lumen's: <ul> <li><a href="https://jobs.lumen.com/global/en/benefits-statement" target="_blank">Benefits*</a></li> <li><a href="https://jobs.lumen.com/global/en/compensation-information" target="_blank">Bonus Structure</a></li> </ul> #LI-MK1 Requisition #: 337503 Background Screening If you are selected for a position, there will be a background screen, which may include checks for criminal records and/or motor vehicle reports and/or drug screening, depending on the position requirements. For more information on these checks, please refer to the Post Offer section of our <a href="https://jobs.lumen.com/global/en/faq" target="_blank">FAQ page</a>. Job-related concerns identified during the background screening may disqualify you from the new position or your current role. Background results will be evaluated on a case-by-case basis. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Equal Employment Opportunities We are committed to providing equal employment opportunities to all persons regardless of race, color, ancestry, citizenship, national origin, religion, veteran status, disability, genetic characteristic or information, age, gender, sexual orientation, gender identity, gender expression, marital status, family status, pregnancy, or other legally protected status (collectively, “protected statuses”). We do not tolerate unlawful discrimination in any employment decisions, including recruiting, hiring, compensation, promotion, benefits, discipline, termination, job assignments or training. Disclaimer The job responsibilities described above indicate the general nature and level of work performed by employees within this classification. It is not intended to include a comprehensive inventory of all duties and responsibilities for this job. Job duties and responsibilities are subject to change based on evolving business needs and conditions. In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information. Please be advised that Lumen does not require any form of payment from job applicants during the recruitment process. All legitimate job openings will be posted on our official website or communicated through official company email addresses. If you encounter any job offers that request payment in exchange for employment at Lumen, they are not for employment with us, but may relate to another company with a similar name. Application Deadline 03/29/2025

Lead Client Escalations Manager

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 *Must Live/ work in PST*The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services. We work closely with both case management team and utilization management team. • The Care Management Associate will review eligibility and benefits and open pre-certification cases and either approve or send to nursing staff for review. • The Care Management Associate role include: • Responsible for initial review and triage of Care Team tasks. • Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools. • Screen patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan. • Monitors non-targeted cases for entry of appropriate discharge date and disposition. • Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff. • Identifies triggers for referral into Aetna’s Case Management, Disease Management, Mixed Services, and other Specialty Programs. • Utilizes Aetna systems to build, research and enter member information, as needed. • Support the Development and Implementation of Care Plans. • Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services • Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively) • Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases • Provides support services to team members by answering telephone calls, taking messages, researching information, and assisting in solving problems. • Adheres to Compliance with PM Policies and Regulatory Standards. • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. • Protects the confidentiality of member information and adheres to company policies regarding confidentiality. • May assist in the research and resolution of claims payment issues. • Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures. Required Qualifications Minimum of 6 months of call center experience required. Must live/work in PST Preferred Qualifications • Effective communication, telephonic and organization skills. • Familiarity with basic medical terminology and concepts used in care management. • Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members. • Computer literacy to navigate through Internal/external computer systems, including Excel and Microsoft Word. EducationHigh School Diploma or equivalent experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $31.72This 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. 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: 02/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Care Management Associate

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.<h2>Position Summary</h2>Help us elevate our member care to a whole new level! Join our Aetna Team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across the country.The Transition of Care Coach is responsible for care coordination of our members who are experiencing a significant change in health status which has resulted in the necessity of an emergency department visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered/Licensed RN, the TOC Coach ensures the member experiences a seamless transition to their next care setting and facilitates post-discharge goal attainment by:<ul> <li>Complete post-discharge questionnaire, which may be market specific.</li> <li>Ensures the member has filled/received their medication(s) and has an understanding on how to take their ordered medications.</li> <li>Benefit education</li> <li>Monitor members in low CM level for alerts or changes in condition to be transitioned back to RN.</li> <li>Complete post discharge call and required assessments (RAP), medication reconciliation (if within scope of practice), fall assessment if fall risk identified.</li> <li>Complete inpatient confinement calls and monitoring for discharge.</li> <li>Management of warm transfers form concierge and engagement hub</li> <li>Provides clinical assistance to determine appropriate services and supports due to member’s health needs (including but not limited to: Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports)</li> <li>Evaluation of health and social indicators</li> <li>Identifies and engages barriers to achieving optimal member health.</li> <li>Uses discretion to apply strategies to reduce member risk.</li> <li>Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member’s condition(s) and abilities to self-manage.</li> <li>Coordinates post-discharge meal delivery, assists with securing DME, and helps to ensure timely physician follow-up.</li> <li>Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel.</li> </ul>Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality.Job Responsibilities Responsible for completing outreach cadence calls and post-discharge questionnaires within required compliance driven timelines.Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and 30-day hospital readmissions.Follows members identified as inpatient in hospitals (whether planned or unplanned admission) and then throughout the subsequent care continuum until member can return to prior level of functioning in the community.Facilitates Interdisciplinary Care Team Meetings with Social Services, Care Management, PCP and other key players to discuss service needs and support safe transitions.<h2>Required Qualifications</h2><ul> <li>This position is a REMOTE position but the candidate must reside in either New Jersey Compact or New York</li> <li>2+ years LPN nursing experience</li> <li>Self-motivated, energetic, detail-oriented, highly organized, tech-savvy Licensed Practical Nurses</li> <li>Discharge planning</li> <li>Advanced proficiency in Microsoft Word, Excel, and Outlook</li> <li>Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment while providing outstanding care</li> <li>Effective verbal and written communication skills</li> </ul><h2>Preferred Qualifications</h2><ul><li>Bilingual (English and Spanish)</li></ul> <h2>Education</h2> <ul> <li>High School Diploma/GED or equivalent experience (REQUIRED)</li> <li>Licensed Practical Nurse (LPN) (REQUIRED)</li> <li>Associate's Degree or Bachelor's Degree (PREFERRED)</li> </ul> Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$24.64 - $53.53This 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: 04/14/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Transition of Care Associate (Must reside in New Jersey or New York)

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.The Medical Economics Unit (MEU) is responsible for identifying and mitigating medical cost trends for the Aetna business unit. We are hiring for a position to assist in the analysis and compliance of the Mental Health Parity and Addiction Equity Act (MHPAEA) regulatory requirements. As a Manager of Medical Economics, you will work closely with compliance, network and other MEU teams to assist with data requests, analytics, documentation and rate setting.Responsibilities you would manages, lead, or participates in (e.g. Medical Cost Savings Initiatives):<ul> <li>Project Management accountabilities include project oversight including initiation, identification and completion of key deliverables to ensure all business objectives are met.</li> <li>Responsible for the development and implementation of key medical economics business efforts e.g. medical cost initiatives, policies/programs and analytical models.</li> <li>Accountable for all financial projections associated with project.</li> </ul>In this role you will be able to demonstrate:<ul> <li>Ability to analyze data and information and summarize findings for a variety of stakeholders.</li> <li>Lead and own all financial projections within the projects</li> <li>Ability to communicate effectively</li> <li>Ability to quickly grasp business concepts, objectives, and strategies and summarize them</li> <li>Proven experience leading cross-functional, matrixed projects and programs</li> <li>Strong attention to detail, organizational skills, and the ability to manage multiple tasks while meeting deadlines</li> </ul>Qualifications:<ul> <li>5-7 years work experience</li> <li>3 + years experience collaborating across the enterprise business segments to understand business needs and requirements</li> <li>Experience developing and implementing new ideas that support the program work and team, while helping the company achieve compliance with regulatory requirements</li> <li>Experience influencing change to improve processes, organization effectiveness and systems</li> <li>Assist others to identify solutions to issues that negatively impact the program and/or project goals</li> </ul>Preferred Qualifications<ul> <li>Knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.</li> <li>Comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.</li> <li>Understanding of internal and external database applications.</li> </ul>Education<ul><li>Bachelor's Degree or equivalent work experience required</li></ul>**This is a hybrid role located at a CVS hub or remote*****The role does not offer sponsorship***Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $159,120.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/21/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Manager, Medical Economics

Senior Internal Audit Manager

About Lumen Lumen connects the world. We are igniting business growth by connecting people, data and applications – quickly, securely, and effortlessly. Together, we are building a culture and company from the people up – committed to teamwork, trust and transparency. People power progress. We’re looking for top-tier talent and offer the flexibility you need to thrive and deliver lasting impact. Join us as we digitally connect the world and shape the future. <h2>The Role</h2> The Vendor Management Office (VMO) is currently seeking an individual who will manage our participation in the Cloud Initiative Program, which involves an expansive portfolio of contractual reviews, maintenance and subscription renewals, software purchases and renewal transactions, business-impacting decisions, with adherence to best practices and to ensure cohesive relationships with cross-functional teams. Work assignments will include many vendor products including major IT industry vendors. In addition to analytical skills, primary consideration will be given to candidates with experience in: - Multiple major Cloud platforms, their marketplace software offerings, and management of software contracts. - Project Management, preferably with PMP/PMI certifications. Collaborate with Transformation, Engineering, Planning and Network (STEPN) teams, the IT Transformation Program Management Office (PMO), and Procurement in Cloud Initiative Programs, goals like schedule, cost, and quality. This position will ensure members prioritize work to review Lumen's software licensing contracts and relationships; keep track of license renewal billing under the Special Projects budget; manage associated risks. Align plans with business needs, aim for optimal terms, and adapt to vendor actions. The position serves as an internal consultant for VMO members, supplementing the team’s understanding of Lumen’s cloud transformation initiatives, emerging cloud offerings, and marketplace operations from Lumen’s cloud partners. Act as a project manager for vendor transactions, ensuring timely decisions. financial impacts of transactions and provide recommendations on renewals of software maintenance and subscriptions based on cost, value, and risks. Follow internal processes to measure and document team performance. <h2>The Main Responsibilities</h2> - Represent the SAM/VMO team on the various Transformation Workstream meetings and engage additional SVMs or SAMs (Software Asset Managers), as needed - Create and update tracking mechanisms for SAM/VMO related action items, costs, ownership and status to other organizations; partner with VMO management team to ensure that tracking and reporting supports program objectives. - Facilitate and lead discussions on behalf of the SAM/VMO Team with workstreams, procurement, Transformation PMO, FinOps, security, legal, finance, and technical teams, etc. as assigned - Create metrics for and prepare executive presentations on SAM/VMO Transformation activities - Supplement SAM/VMO capacity to review contracts and published licensing terms; understand technical roadmaps; assess software license position (entitlement vs. usage); propose contractual risk mitigations. <h2>What We Look For in a Candidate</h2> - Strong analytical and project management skills: contract analysis, data analysis, financial analysis (budget and forecasts, accounting concepts, evaluation of alternatives), process analysis. Understand necessary information; discern relevant facts for decisions. Maintain focus on details, while keeping the big picture in mind. Communicate complex concepts and actionable recommendations to leadership. - Ability to determine root cause of operational and financial challenges and offer options for risk-based mitigation. - Ability to lead and work in a team, be self-directed (requires minimal supervision to manage multiple initiatives simultaneously), creative problem solver, quality - focused; applies independent judgment to accomplish objectives. - Demonstrates strong and positive interpersonal talents; able to interact with and influence people from all disciplines; able to balance persuasiveness and assertiveness to build relations while meeting objectives. - Approaches situations with curiosity; assumes positive intent; expresses appreciation; manages mood elevators; seeks and provides feedback. Preferred: - Complex software contracts and licensing for a variety of suppliers, both major industry vendors (e.g., Microsoft, Google, Oracle, AWS) and others less well known. Contractual, financial, and project management support for implementation of IT cloud strategy, including displacement of legacy software products, implementation of new cloud technologies, purchasing via marketplaces, enabling FinOps. Representing and addressing IT’s considerations and interests (from development to infrastructure operations), while conducting vendor-related activities. Financial transactions and purchasing tools. - 6 – 8 years of related experience. Education - Bachelor’s degree with an emphasis in business (e.g., finance, operations, statistics, economics), MIS, Information Technology, Computer Science or comparable years of work experience. Master’s degree is a plus. <h2>Compensation</h2> This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Individual pay is based on skills, experience and other relevant factors. Location Based Pay Ranges $103,711 - $138,281 in these states: AL AR AZ FL GA IA ID IN KS KY LA ME MO MS MT ND NE NM OH OK PA SC SD TN UT VT WI WV WY $108,896 - $145,195 in these states: CO HI MI MN NC NH NV OR RI $114,082 - $152,109 in these states: AK CA CT DC DE IL MA MD NJ NY TX VA WA Lumen offers a comprehensive package featuring a broad range of Health, Life, Voluntary Lifestyle benefits and other perks that enhance your physical, mental, emotional and financial wellbeing. We're able to answer any additional questions you may have about our bonus structure (short-term incentives, long-term incentives and/or sales compensation) as you move through the selection process. Learn more about Lumen's: <a href="https://jobs.lumen.com/global/en/benefits-statement" target="_blank">Benefits*</a> <a href="https://jobs.lumen.com/global/en/compensation-information" target="_blank">Bonus Structure</a> Requisition #: 336784 Background Screening If you are selected for a position, there will be a background screen, which may include checks for criminal records and/or motor vehicle reports and/or drug screening, depending on the position requirements. For more information on these checks, please refer to the Post Offer section of our <a href="https://jobs.lumen.com/global/en/faq" target="_blank">FAQ page</a>. Job-related concerns identified during the background screening may disqualify you from the new position or your current role. Background results will be evaluated on a case-by-case basis. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Equal Employment Opportunities We are committed to providing equal employment opportunities to all persons regardless of race, color, ancestry, citizenship, national origin, religion, veteran status, disability, genetic characteristic or information, age, gender, sexual orientation, gender identity, gender expression, marital status, family status, pregnancy, or other legally protected status (collectively, “protected statuses”). We do not tolerate unlawful discrimination in any employment decisions, including recruiting, hiring, compensation, promotion, benefits, discipline, termination, job assignments or training. Disclaimer The job responsibilities described above indicate the general nature and level of work performed by employees within this classification. It is not intended to include a comprehensive inventory of all duties and responsibilities for this job. Job duties and responsibilities are subject to change based on evolving business needs and conditions. In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information. Please be advised that Lumen does not require any form of payment from job applicants during the recruitment process. All legitimate job openings will be posted on our official website or communicated through official company email addresses. If you encounter any job offers that request payment in exchange for employment at Lumen, they are not for employment with us, but may relate to another company with a similar name. Application Deadline 04/08/2025

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