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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary The Sr. Service Advocate serves as the Single Point of Contact for handling member service inquiries, issues and process requests received via telephone. Acts with fast knowledge using integrated service tools. Engages, consults and educates members based upon the member's unique needs, preferences and understanding of the ISM suite of services. Required Qualifications • Ability to build a trusting relationships by taking accountability to fully understand the member’s needs. • Ability to resolve complex issues with sensitivity and discretion. • Uses communication skills to build relationships with both internal and external members/constituents. • Ability to multitask and handle multiple functions and/or multiple products while maintaining and/or exceeding performance standards. • Demonstrates professionalism and presents a positive image when interacting with members and constituents. • Demonstrates strong member focus and utilizes all available resources to ensure prompt member satisfaction. • Demonstrates functional expertise and leadership ability. • Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate. Preferred Qualifications Strong communication skills Understanding of medical terminology Problem solving skills Computer literate, Microsoft Word and Excel experience a plus Education High School Diploma or G.E.D. Some college preferredAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $38.82This 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: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Senior Service Advocate

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 SummaryUtilization management is a 24/7 operation. Work schedules will include weekend, evening and holiday rotations. Must reside in the PST zoneAs a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care- Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.- Typical office working environment with productivity and quality expectations.- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.- Sedentary work involving periods of sitting, talking, listening.- Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.- Effective communication skills, both verbal and written Required Qualifications- 2 years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications- 2 years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management- Preference for those residing in PST zones - Bachelor of Science in Nursing EducationAssociates Degree in NursingAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management, 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

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 Ready to take your Medical Director skills to the next level with a Fortune 6 company? Check out this opportunity with Aetna, a CVS Health company! This is a remote based work from home role. The Aetna One Advocate model provides the member with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition. Some key daily activities: - Partner with other Advocate team members to holistically assess member’s needs - Collaborate with treating providers through personalized, creative solutions to help member’s meet their health care needs. - Lead the clinical staff in the coordination of quality care on behalf of members - Conduct educational and clinical rounds with A1A clinical staff - Provide clinical expertise and business direction in support of medical management and utilization review programs through participation in clinical team activities including precertification, concurrent review/discharge planning, case management, disease management and quality management - Provide clinical guidance in promoting member quality of care and reviewing/addressing potential lapses - Act to engage providers and facilities in improving the quality of care delivered to our members and assure that our shared relationships are maintained and improved - Proactively use data analysis and periodic assessments to identify opportunities for quality improvement - Work collaboratively with other functional areas that interface with medical management including provider relations, sales, benefits, healthcare delivery, national medical services and national accounts to achieve the business goals Required Qualifications *Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. Preferred Qualifications *Health Plan experience Education*M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experiencePay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 07/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director (Aetna One Advocate)

At 2U, we are all in on purpose. We are motivated by our mission – to eliminate the back row in education – and connected by our shared passion to deliver world-class digital education at scale. As the parent company of edX, the world’s leading online learning platform, 2U powers more than 4,000 online higher education offerings – from free courses to full degrees. Together with more than 230 colleges, universities, and corporate partners, we are helping to unlock human potential. What We’re Looking For: VP of Engineering at 2U, Inc. will be the next Technology Executive to join 2U’s innovative mission and to become part of its dynamic and invigorating culture. You will be tasked with leading efforts in product innovation as well as process and operational change in our New York City office. Taking an active, creative, and practical approach, the VP of Engineering will work closely with the CTO, the existing product development team and other technology-focused leadership to achieve and execute the strategic goals of the organization. The ideal candidate should have a notable background in developing cutting-edge products and managing functional operations across multiple initiatives. Applicable skills and experience are paramount, as well as an interest in our mission and shared values of 2U. Key Role and Responsibilities: <ul> <li>Establish Business Processes specific to the objectives of the 2U TechDev group</li> <li>Work alongside the CTO to ideate and think big-picture about what’s next</li> <li>Evaluate and recommend solutions that enhance company-wide productivity as well as enhance and increase 2U partner resources</li> <li>Collaborate with other leadership in tech to successfully implement engineering KPI measurements, and monitoring to establish engineering best practics</li> <li>Partner with our internal coaches to help XP teams deliver technically excellent software of demonstrated value.</li> <li>Make strong, confident, outside-the-box decisions that affect the future of 2U technology and the business as a whole</li> <li>Areas of responsibilities are CRM consolidation and and various Learning Management Systems</li> <li>Proactive use of AI tools for process automation and SDLC</li> </ul> Education and Experience: <ul> <li>10+ years of leadership experience in an environment with robust technical products and constant innovation</li> <li>Excellent business judgment, communicative, and interpersonal skills that result in the ability to work effectively with leadership, teams and external clients</li> <li>A willingness to create, identify and leverage cutting-edge technologies at an enterprise level</li> <li>Proven ability to understand a product vision and execute on it</li> <li>Ability to discern in a buy vs. build situation</li> <li>Demonstrable Process Management experience in an SDLC environment of continual change</li> <li>Bachelor’s degree in Computer Science, Business Administration, Mathematics, Engineering or a related major or equivalent work experience</li> </ul> Other attributes that will help you <ul> <li>Experience with data products and learning focused product management products</li> <li>Strong technical acumen; we use Python, JavaScript, MongoDB, Salesforce, Jira, AWS </li> <li>Familiarity with Agile/XP technical practices including Test Driven Development, Pair programming, Continuous Integration, etc.</li> <li>Familiarity with various Generative AI and process automation tools</li> <li>Track record of choosing technologies that succeed in a corporate infrastructure</li> <li>Have proven experience making outside-the-box decisions, open to change</li> <li>Start-up experience a huge plus</li> </ul> Working Conditions N/A Physical Requirements N/A Management Responsibilities While this position is open to remote candidates across the U.S., we will prioritize those who live in the Washington-Baltimore metropolitan area and who are available to come into our Headquarters in Arlington, VA two days a week. Benefits &amp; Culture Our global employee base is a diverse collection of innovators, dreamers, and doers working together to transform lives through higher education. We believe that every employee can advance our shared purpose, and that life at 2U should be fun and meaningful. If you’re excited by the opportunity to provide over 40 million learners and counting with access to world-class online higher education, then join us – and do work that makes a difference. #NoBackRow We offer comprehensive benefits (unique per country) and excellent work/life balance. Full-time, U.S.benefits include: <ul> <li>Medical, dental, and vision coverage</li> <li>Life insurance, disability, and 401(k) employer match</li> <li>Free snacks and drinks in-office</li> <li>Generous paid holidays and leave policies, including unlimited PTO</li> <li>Additional time off benefits include: volunteer days, parental leave, and a company-wide winter break</li> </ul> The anticipated base salary range for this role is ($240,000 - $297,000), with potential bonus eligibility. Salary offers are made based on the candidate’s qualifications, experience, skills, and education as they directly relate to the requirements of the position, budget for the position and cost of labor in the market in which the candidate will be hired. 2U Diversity and Inclusion Statement At 2U, we are committed to building and sustaining a culture of belonging, respect, and inclusion. We are proud of the steps we’ve taken to bring together an employee base that embodies diverse walks of life, ideas, genders, ages, races, cultures, sexual orientations, abilities and other unique qualities. We strive to offer a workplace where every employee feels empowered by what makes us different, as well as by how we are alike. 2U is committed to providing reasonable accommodations during our recruitment process. If you need assistance or accommodations, please reach out to us at: <a href="#">recruitingaccommodations@2u.com</a>. About 2U LLC For more than a decade, 2U, Inc. has been the digital transformation partner of choice to great non-profit colleges and universities delivering high-quality online education at scale. As the parent company of edX, a leading global online learning platform, 2U provides over 45 million learners with access to world-class education in partnership with more than 230 colleges, universities, and corporations. Our people and technology are powering more than 4,000 digital education offerings — from free courses to full degrees — and helping unlock human potential. To learn more: visit 2U.com. About edX edX is the education movement for restless learners and a leading global online learning platform from 2U, LLC. Together with the majority of the world’s top-ranked universities and industry-leading companies, we bring our community of over 45 million learners world-class education to support them at every stage of their lives and careers, from free courses to full degrees. And we're not stopping there — we're relentlessly pursuing our vision of a world where every learner can access education to unlock their potential, without the barriers of cost or location. Learn more at edX.org. Learn more at <a href="https://2u.com/careers/" target="_blank">https://2u.com/careers/</a> #NoBackRow The above statements are intended to describe the general nature and level of work performed by individuals assigned to this position, and are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required. All employees may be required to perform duties outside of their normal responsibilities from time to time, as needed. 2U is an equal opportunity employer that does not discriminate against applicants or employees and ensures equal employment opportunity for all persons regardless of their race, creed, color, religion, sex, sexual orientation, gender identity, pregnancy, national origin, age, marital status, disability, citizenship, military or veterans’ status, or any other classifications protected by applicable federal, state or local laws. 2U’s equal opportunity policy applies to all terms and conditions of employment, including but not limited to recruiting, hiring, training, promotion, job benefits and pay.

2U Inc.

Vice President, Engineering

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 SummaryUtilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.<ul> <li>Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care</li> <li>Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs</li> <li>Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization</li> <li>Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.</li> <li>Typical office working environment with productivity and quality expectations.</li> <li>Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.</li> <li>Sedentary work involving periods of sitting, talking, listening.</li> <li>Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.</li> <li>Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.</li> <li>Effective communication skills, both verbal and written</li> </ul>Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting- Must have active current and unrestricted RN licensure in state of residence- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management- Preference for those residing in central time zones EducationAssociates Degree requiredBSN preferredAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$29.10 - $62.32This 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: 05/12/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management 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<ul> <li>Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. </li> <li>Acts as a subject matter expert by providing training, coaching, or responding to complex issues. </li> <li>May handle customer service inquiries and problems.</li> </ul>Additional Responsibilities <ul> <li>Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. </li> <li>Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process.</li> <li>Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals.</li> <li>Insures all compliance requirements are satisfied and all payments are made against company practices and procedures.</li> <li>Identifies and reports possible claim overpayments, underpayments and any other irregularities.</li> <li>Performs claim rework calculations.</li> <li>Distributes work assignment daily to junior staff.</li> <li>Trains and mentors claim benefit specialists.</li> <li>Makes outbound calls to obtain required information for claim or reconsideration.</li> </ul>Required Qualifications<ul> <li>2+ years medical claim processing experience.</li> <li>Experience in a production environment.</li> <li>Demonstrated ability to handle multiple assignments competently, accurately and efficiently.</li> </ul> Preferred Qualifications<ul> <li>Self funded medical claim processing experience.</li> <li>DG system knowledge.</li> </ul>Education<ul> <li>High School Diploma or GED required.</li> <li>Preferred Associates degree or equivalent work experience.</li> </ul>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: 05/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Claim Benefit Specialist

Regent Bank

SBA LOAN OFFICER

Salary Range $62,000 - $80,000*Job Description:Who We Are:Saks is a world-renowned luxury ecommerce destination. The company’s unique approach combines a focus on the digital customer experience with a strong connection to a network of extraordinary stores that extends that seamless experience into the real world. On its website and app, Saks offers an unparalleled selection of curated merchandise across fashion for women and men, beauty, jewelry, home décor and more. In addition to the shopping experience, customers come to Saks for inspiring editorial content, access to digital stylists, lifestyle experiences and other world-class services. The company is driven by significant enhancements to its platforms and offerings, with the goal of becoming the preeminent destination for luxury internationally.Role Summary:The Area Asset Protection Manager is responsible for the overall inventory shortage performance and total execution of the Asset Protection Strategy for their respective stores. This individual will ensure that all company policies, local, provincial, and federal laws are adhered to in the execution of internal and external theft investigations or inquiries. The Area Asset Protection Manager will be working collaboratively with Customer and Associate groups within the store to ensure all objectives are clearly communicated and executed.Key Qualifications:<ul> <li>High School diploma or equivalency required, along with a valid provincial security license (some states). College degree preferred</li> <li>Must satisfy and maintain all licensing requirements (as required by state or local jurisdiction)</li> <li>5+ years of retail Asset Protection Experience, large volume retail environment preferred</li> <li>You are someone with strong aptitude and knowledge of retail security systems, information systems, and productivity software</li> <li>You have a proven track record of identifying shortage exposures and creative strategies to overcome them</li> <li>Wicklander-Zulawski Interview Certification ideal</li> <li>Comfortable with public speaking, technology, and learning on the spot</li> </ul> Who You Are:<ul> <li>Creates a work environment that encourages creative thinking and innovation</li> <li>Actively collaborates and contributes to a positive team dynamic</li> <li>Brings energy and ideas when brainstorming multiple approaches and solutions</li> </ul>Role Description:<ul> <li>Oversee and ensure the integrity of physical inventory by monitoring reports and audits on a daily and monthly basis with the Asset Protection Investigators</li> <li>Consistently communicate with Store Leadership, Managers and Associates to drive awareness of inventory shortage results, shortage concerns and strategy initiatives</li> <li>Provide final oversight of audit execution and internal audit readiness</li> <li>Work with sales support to assure shortage control processes are followed</li> </ul> How Often You May Travel:<ul><li>Travel expectation is 50% of your time between stores.</li></ul>Your Life and Career at Saks:<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> At this time, we are not providing immigration sponsorship/support for this role.Thank you for your interest in Saks. We look forward to reviewing your application. Saks 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 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.Saks welcomes all applicants for this position. Should you be individually selected to participate in an assessment or selection process, accommodations are available upon request in relation to the materials or processes to be used.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

Area Asset Protection Manager

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 Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. **This is a remote based (work at home) based anywhere in the US.**The Medical Director (Ortho/Total Joint) will be a Subject Matter Expert (SME) with a background in Orthopedic specialty, including post-graduate direct patient care experience specifically. This role expands Aetna's medical management programs to address member needs across the continuum of care. In this role you'll support the Medical Management staff ensuring timely and consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management. In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities You'll act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams In addition, you will be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise Required Qualifications* 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. * Active and current state medical license without encumbrances * M.D. or D.O., Board Certification in an Orthopedic specialty including post-graduate direct patient care experience specifically Preferred Qualifications * Previous healthcare insurance experience. Education * M.D. or D.O., Board Certification in an Orthopedic specialty.Pay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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