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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 SummaryThis position will be on the Aetna Voluntary Underwriting team and is responsible for new business and renewal underwriting for Accident, Hospital Indemnity Protection, and Critical Illness products. The Senior Manager will administer strategy for Underwriting to support the organization’s financial and strategic goals, ensuring underwriting decisions are consistent, effective, and compliant.Key Responsibilities:<ul> <li> Strategic Planning &amp; Administration:<ul> <li>Contribute to the planning and administration of company programs and initiatives that promote the Underwriting area’s agenda.</li> <li>Implement organizational policies, goals, and objectives based on best practices in the field.</li> </ul> </li> <li> Underwriting Methodology:<ul> <li>Develop methodology to underwrite voluntary benefits products within established requirements to ensure profitability and achieve a consistent loss ratio target.</li> <li>Align management of large new and renewal group quotations to underwrite profitable business for the region.</li> </ul> </li> <li> Analysis &amp; Reporting:<ul> <li>Deliver analysis and reporting on underwriting key performance indicators and recommend actions for improvement.</li> <li>Advise on competitor activity, third-party activity, and changes in law that may affect underwriting performance.</li> </ul> </li> <li> Product Development:<ul><li>Participate in the design of new voluntary benefits products, ensuring they meet market needs and profitability targets.</li></ul> </li> <li> Team Management:<ul> <li>Manage operational aspects of the team, including budget, performance, and compliance.</li> <li>Implement workforce and succession plans to meet business needs.</li> </ul> </li> </ul> Required Qualifications<ul> <li>7 to 10 years of experience in underwriting.</li> <li>3 to 5 years experience in underwriting voluntary benefits products, including Accident, Hospital Indemnity Protection, and Critical Illness.</li> <li>Proven track record of developing and implementing underwriting strategies that drive profitability and growth.</li> </ul> Preferred Qualifications<ul> <li>Demonstrated ability to develop and execute long-term strategic plans that align with organizational goals.</li> <li>Experience in driving innovation and implementing new initiatives to enhance underwriting processes and product offerings.</li> <li>Experience in collaborating with sales, marketing, and customer service teams to develop and promote customer-focused underwriting solutions.</li> <li>Strong interpersonal skills and the ability to build and maintain relationships with key stakeholders, including clients, brokers, and consultants.</li> <li>Experience in leveraging technology to streamline underwriting processes and improve efficiency.</li> </ul> Education<ul><li>A bachelor’s degree from an accredited institution is required. Preferred fields of study include business administration, finance, economics, mathematics, or a related discipline. An advanced degree (MBA, Master’s) is a plus.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Underwriting Tech Lead

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 This position will support clients in the Central and Eastern time zones.Plans, monitors and manages internal projects from initiation through completion. Secures required resources and uses formal processes and tools to manage resources, budgets, risks and changes. Manages projects to ensure on-time completion according to specifications and within budgeted costs. At the higher levels, incumbents manage large multifaceted projects; at lower levels, incumbents may be concerned with clearly identifiable elements or functions within a larger project. Typically incumbents matched to this function are working towards or have achieved certification in project management.What you will do<ul> <li>Acts as a top-level specialist on project and program planning and develops comprehensive program plans that encompass objectives, deliverables, timelines, and resource allocation.</li> <li>Adapts project and program plans to ensure alignment with business objectives and reinforce organizational standards.</li> <li>Applies highly developed knowledge of financial management principles to manage cost estimation, tracking, and budget reporting for programs and projects.</li> <li>Coaches junior-level project and program managers on how to utilize key performance indicators (KPIs) to measure progress and analyze project and program outcomes.</li> <li>Coordinates knowledge sharing among project teams to highlight success stories and improve project and program management practices through insights.</li> <li>Creates a continuous improvement plan for the project and program department to enhance delivery processes and outcomes.</li> <li>Designs the change management protocol to effectively respond to obstacles that may arise during project and program lifecycles.</li> <li>Utilizes data visualization tools and techniques to present project and program data in a visually appealing easily understandable format.</li> <li>Participates in project/program team training and development activities to enhance project management skills and knowledge.</li> </ul> Required Qualifications<ul> <li>5-10 years of managed care experience</li> <li>Adept at problem solving and decision making skills</li> <li>Adept at collaboration and teamwork</li> <li>Adept at growth mindset (agility and developing yourself and others) skills</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> <li>Adept at business intelligence</li> </ul>Preferred Qualifications or Knowledge of:<ul><li>Preferred experience with HRP, ACAS, EPDB, MedCompass</li></ul> Education Bachelor's degree or equivalent experiencePay RangeThe typical pay range for this role is:$75,400.00 - $165,954.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/04/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Manager, Project Program Management

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 SummaryThe Professional Prod Pharmacist must have expertise and knowledge of the Pharmacy claims appeal process and the various applications used in the appeal process to comply with state bill requirements. In this role, you will be responsible for reviewing and resolving MAC appeals, developing and implementing solutions individually, and being a lead working with IT to automate solutions for complex requirements unique to states with pharmacy bills. This also includes being the appeals team SME in understanding the impact of appeal related issues and resolving them under tight TATs to remain in compliance. The Professional Prod Pharmacist is also responsible for creating reports required to monitor appeal bill compliance, satisfying client reporting requirements for appeals, as well as developing and ensuring the accuracy of appeal reporting as required by state agencies. This role requires a thorough knowledge of claim adjudication in order to perform research, internal claim related processes, and being a leader working with other internal business units to develop new solutions to meet the ever-increasing number of complex pharmacy bill compliance requirements. The position will be responsible for quality control process to ensure compliance.What you will do<ul> <li>Review and resolving MAC appeals</li> <li>Leads with strategic leadership and guidance to pricing teams, ensuring effective response to pharmacy and state department of insurance (DOI) appeals are effectively reviewed and responded.</li> <li>Partner with legal to disposition pharmacy complaints and appeals that come through state agencies</li> <li>Leads and owns the process and work instruction documents that comply with state laws and meets CVS compliance</li> <li>Leads and participate in state appeals audit and exam. Provides the information to state DOI on the inquiries.</li> <li>Interprets and drafts responses to state DOI inquiries and works with CVS legal team to respond to inquiries.</li> <li>Collaborates cross-functionally with legal, compliance, network and other teams to manage the pricing appeals.</li> <li>Counsels and mentor pricing team members, providing guidance and support to enhance their pricing skills and professional development.</li> <li>Delivers pricing solutions and recommendations that drive profitability and revenue optimization and contribute to the overall financial success of the organization.</li> </ul>This is a remote role open to qualified candidates within the United States. Required Qualifications<ul> <li>5+ years relevant work experience</li> <li>2+ years demonstrated experience in managed care (PBM) environment</li> <li>Familiarity with wholesaler invoices</li> <li>Demonstrated ability to work under tight deadlines</li> <li>Excellent Communication, interpreting, writing and leadership skills</li> <li>Ability to prioritize, organize, and manage DOI requests</li> </ul> Preferred Qualifications<ul> <li>1+ years’ experience with all Pharmacy and state department of insurance appeal related processes and state regulations, and claims adjudication, including claims adjudication logic</li> <li>Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal</li> <li>Adjudication system experience</li> <li>Strong mathematical problem-solving skills</li> <li>Prior PBM Knowledge</li> </ul> Education<ul> <li>BS in Pharmacy or Pharm D</li> <li>Current Pharmacist License in good standing, based on applicable state licensing requirements.</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$94,500.00 - $211,200.00This 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: 04/23/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Clinical Pharmacist, Pharmacy Appeals

<h3> Position Summary </h3> As a Senior Risk Specialist, Insider Risk Program, you will join a fast-paced, highly visible team charged with protecting the brand and reputation of the Deloitte US Firm. The Insider Risk team leverages cutting-edge technologies to detect, deter, and mitigate against all types of insiders. As a part of the team, you will be responsible for identifying high-risk behaviors, supporting training initiatives, and offering innovative solutions to protect the Firm’s most valuable assets. Recruiting for this role ends on May 16th, 2025. Work you’ll do Key responsibilities of this position include protecting Deloitte people, data, and information systems by leveraging a User Behavioral Analytics Tool to investigate insider threat risk indicators: <ul> <li>Apply program management skills to contribute to the daily operations of a mature insider threat program.</li> <li>Support highly visible, small team in day-to-day responsibilities: conduct data analysis, develop reporting and presentation content.</li> <li>Conduct in depth analysis of information received from various data sources: assemble, correlate, evaluate, and assess information concerning insider threats to personnel, confidential information, and information systems.</li> <li>Technical application: leverage a user behavioral analytics tool to develop a holistic understanding of potential high-risk employee behavior.</li> <li>Enhance the tool: research, organize, and facilitate data ingestion for new data feeds including data field mapping.</li> <li>Ability to troubleshoot the root causes of issues, develop solutions, document, and communicate findings.</li> <li>Conduct testing across multiple environments to validate new functionality or fixes for issues.</li> </ul> The successful candidate will possess: <ul> <li>Ability to work in multidisciplinary environment: collaborate with a variety of stakeholders to resolve investigations and mitigate risk.</li> <li>Strong written and presentation skills: develop briefings for key stakeholders based on trend analysis and identifying new opportunities for program maturation.</li> <li>Technical aptitude and willingness to learn.</li> <li>Possess high quality analytical, investigative, and problem-solving skills.</li> <li>Excellent verbal and written business communication skills.</li> <li>Excellent organizational and time management skills.</li> <li>Attention to quality and detail a must.</li> <li>Ability to apply critical thinking in evaluating different scenarios.</li> <li>Ability to handle confidential and sensitive information with appropriate discretion.</li> <li>Ability to prioritize work and operate independently; know when to seek guidance.</li> <li>Ability to organize and manage multiple projects simultaneously.</li> </ul> The team The Insider Risk Program resides within the Deloitte U.S. Firm’s Confidentiality and Privacy Office. The Confidentiality and Privacy Office is part of the Risk and Brand Protection organization within Deloitte LLP The Insider Risk Program is a part of Deloitte’s Enabling Areas within the Risk and Brand Protection group under Confidentiality and Privacy. This role is not client facing; we support our client-facing professionals in delivering high-quality trusted service to our clients. Qualifications Required: <ul> <li>Bachelor’s Degree is required</li> <li>Understanding of insider threat principles, programs, and analytical work</li> <li>Background or exposure to investigative processes</li> <li>Experience with technical implementation, data source ingestion, testing, and/or systems operations</li> <li>Exposure to cyber security applications, tools, and/or software </li> <li>Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future</li> <li>Ability to travel 0-10%, on average, based on the work you do and the clients and industries/sectors you serve</li> </ul> Preferred: <ul> <li>SDLC, agile methodology, and implementations</li> <li>Experience in confidentiality, privacy, or security fields</li> <li>Experience with O&amp;M or troubleshooting issues</li> <li>Experience or use of Behavioral Analytical tools</li> <li>Knowledge of integrating data feeds and validating data ingestion</li> <li>Ability to conduct detailed testing and understanding of testing cycles</li> </ul> Information for applicants with a need for accommodation: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $66,200-$121,800. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Deloitte

Insider Risk Sr Specialist

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryManage the development, submission, and state approval process for insurance form filings. Key Responsibilities:<ul><li>Drafting and reviewing product filings:</li></ul>Draft Medicare Supplement and short-term limited duration health insurance products (policies, forms, brochures, etc.) to ensure compliance with all applicable laws, regulations, and guidelines.<ul><li>Compliance:</li></ul>Verify that the products meet specific requirements regarding benefits, premium structures, eligibility, and other relevant aspects.<ul><li>Regulatory Updates:</li></ul>Stay abreast of changes in state and federal regulations related to Medicare supplement insurance.<ul><li>Record Keeping:</li></ul>Maintain accurate records of product filings and related correspondence.<ul><li>Coordination:</li></ul>Collaborate with other business areas and stakeholders within the company throughout the product filing and approval process.<ul><li>Specialized Knowledge:</li></ul>Possess a strong understanding of Medicare supplement and short term, limited duration health insurance products including and their benefits. Required Qualifications<ul> <li>Minimum of five (5) years of work experience in insurance product development and a policy forms drafting capacity with a health insurance carrier.</li> <li>Minimum of five (5) years of work experience with, health insurance products, specifically including Medicare Supplement and short-term limited duration health insurance plans, products, applicable regulations, and industry practices.</li> <li>Familiarity with legal research and review of applicable statutes and regulations.</li> <li>Strong analytical skills with the ability to review and analyze complex data and documents.</li> <li>Experience with independently drafting complex health insurance policy documents, applications, policy riders, and outlines of coverage.</li> <li>Strong attention to detail, in particular accuracy and meticulousness in reviewing and processing filings via SERFF.</li> <li>Excellent ability to communicate effectively, both verbally and in writing to effectively coordinate and communicate with internal business partners and insurance departments.</li> <li>Problem-Solving Skills: Ability to identify and resolve issues related to product filings.</li> <li>Software Proficiency: Proficiency in relevant software and databases such as Microsoft Word, Microsoft Teams, Adobe, PowerPoint, and Workfront. </li> <li>Experience with responding to insurance department questions and objections in response to insurance product filings.</li> <li>Extensive knowledge of insurance department rules and regulations governing coverage forms, endorsements, rules, and policy language requirements.</li> <li>Maintains a high level of confidentiality and professional demeanor and approach in the performance of duties.</li> <li>Must possess initiative to work independently without frequent supervisory involvement.</li> <li>Ability to quickly understand new insurance products and product changes.</li> <li>Possess high organizational skills and ability to set and adjust priorities.</li> <li>Ability to make decisions within scope of authority.</li> </ul>Preferred Qualifications Education High School diplomaAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$46,988.00 - $122,400.00This 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: 05/05/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Analyst, Product & Regulatory Approvals

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.Requisition Job DescriptionAt Aetna, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas members. We value diversity and are dedicated to helping you achieve your career goals.In this Aetna Network Management Role individual contributor role the contract negotiator:<ul> <li>Negotiates competitive contracts with health care providers using pre-determined internal guidelines and financial standards.</li> <li>Negotiates contract language in accordance with Aetna standards, engaging other departments as needed for review and approval of contract terms outside the standards.</li> <li>Conducts competitive and financial analyses to achieve best in market discounts and financial results that are within pre-determined targets.</li> <li>Manages contract performance and works with various internal departments to address questions, issues, and activities related to execution, loading, and ongoing maintenance of provider contracts.</li> <li>Negotiates and supports the implementation of value-based contract relationships in support of business strategies.</li> <li>Manages relationships with key providers and ensures resolution of escalated issues related, but not limited to, claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information.</li> <li>Negotiates settlements as needed. May recruit providers as needed to ensure network adequacy and achievement of network expansion goals. Maintains accountability for specific medical cost initiatives.</li> <li>Candidates residing in Texas Preferred; however, not required. </li> </ul>Required Qualifications<ul> <li>3+ years of experience negotiating contracts with ancillary providers, physician groups, and IPAs, including contract language, development, and analysis of rate proposals, identifying operational and financial improvement opportunities, and collection and analysis of competitive data and key financial metrics. Uses competitive and financial data, as well as analysis detail, to negotiate favorable contracts.</li> <li>3+ years of working knowledge of complex contracting options, provider reimbursement methodologies and terms, and contract setup. Understanding of provider financial issues, industry standard payment policies, regulatory requirements, and competitor strategies. </li> <li>Must be proficient in Word, Excel, and Microsoft Office.</li> </ul> Preferred Qualifications<ul> <li>Professional and Ancillary contracting experience.</li> <li>Strong critical thinking, problem resolution, organization, communication, and interpersonal skills. </li> <li>Able to successfully manage multiple negotiations, issues, and other tasks to ensure completion and meet deadlines. </li> <li>Able to manage expectations and maintain strong relationships, both internally and externally.</li> <li>Experience negotiating and/or managing value-based contracts brings added value.</li> </ul> Education <ul><li>Bachelor’s Degree or equivalent combination of education and professional 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: 06/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Mgr,Contract Negotiation

<h3> Position Summary </h3> As a senior member of Records &amp; Contracts (R&amp;C), the R&amp;C Senior Manager: Compliance &amp; Reporting leads teams (within US and India), and is responsible for complex, highly visible, and transformative records and contracts compliance programs and initiatives for the Deloitte US Firm. The Senior Manager develops strategy, oversees the execution of all associated processes, and directs interactions with senior level cross-functional stakeholders resulting in the digitization, modernization, automation, and transformation of both R&amp;C as well as business processes. Activities are focused on records and contracts management programs that have an impact at all levels of the organization, resulting in improved records and contracts related outcomes, further risk mitigation and desired people-related outcomes, while maintaining and promoting process, information, and system performance, overall cost reduction or avoidance, and adherence to the organization’s records and contracts management and confidentiality, privacy, and information security policies. Responsibilities include: <ul> <li>As a member of the R&amp;C Leadership team, directs the development, execution, management, oversight, and enhancement of records and contracts compliance projects and processes with overall R&amp;C mission and Firm objectives. Drives integrated, cohesive decision-making across records and contracts programs</li> <li>Designs, develops, implements, and evaluates the effectiveness of highly innovative records and contracts compliance and reporting projects that provide business analytics and intelligence, supporting cross-functional transformation goals. Implements technology solutions, including generative AI solutions, to deliver insights that address business, regulatory and legal challenges</li> <li>Accountable and responsible for embedding records and contracts compliance into firm culture and establishing a roadmap for future compliance efforts, drives meaningful and actionable reporting to the highest levels of firm leadership</li> <li>Develops and executes records and contracts management strategies and programs of extensive scope, extraordinary complexity, and Firm-wide impact. Leads compliance and reporting team in the definition, planning, execution, and enhancement of compliance and reporting programs. Ensures alignment of R&amp;C programs with R&amp;C strategy, as well as overall Firm strategies</li> <li>Accountable and responsible for multi-year and multi-faceted projects including resources, governance, schedule, economics, risk mitigation, contingency planning, compliance with regulations and standards, as well as business continuity.</li> <li>Provides intellectual leadership and promotes awareness of emerging and current business trends, operating conditions, and internal processes and initiatives that may impact records and contracts compliance programs. Devises strategies for changes. Designs and implements innovative processes and procedures and adapts approaches to increase efficiencies, improve organization, and enhance services provided.</li> <li>Engages with key cross-functional stakeholders (Risk, OGC, ITS, business stakeholders, Enabling Areas stakeholders, and functional leadership) to understand their needs and forge highly productive relationships (based on a high degree of trust) that benefit the businesses and the R&amp;C programs. Leverages those associations to present innovative solutions and demonstrate the “art of the possible” leading to significant cultural and behavioral transformation.</li> <li>Leads cross-functional strategy sessions to support enterprise-wide decision-making, program development (functional and technical) and enhancements that align with business and Firm-wide priorities. Gains consensus and then drives change across all business areas and levels.</li> </ul> Recruiting for this role ends on March 16, 2025 The successful candidate will possess: <ul> <li>Experience and ability to effectively interact and work productively with business and enabling areas leadership and other stakeholders across all levels of Deloitte to make recommendations and resolve issues.</li> <li>Advanced program management and program planning; excellent team leadership skills.</li> <li>Ability to work with and maintain positive working relationships (while also conveying records and contracts management perspectives) with virtual and global business teams and internal clients.</li> <li>Experience with large complex transformations that require strategic thinking and the ability to see them through execution.</li> <li>Ability to manage multiple complex, multi-functional, multi-year projects simultaneously</li> <li>Proven ability to lead high visibility, substantial and high impact change management strategies/implementations.</li> <li>Demonstrated advanced proficiency with MS Office, SharePoint; ability to operate database software, including searching, using queries, and running reports.</li> <li>In-depth understanding of information/records/contracts management principles, processes and policies, design, systems/applications, and functions</li> <li>Demonstrated proficiency in data and analytics, and/or data management experience.</li> <li>Strong understanding of governance, risk, and compliance</li> <li>Ability to comprehend and correlate business objectives with records and/or contracts management solutions/projects; provides high-quality records and/or contracts management solutions to records/contracts related business problems.</li> <li>Superior organization, consultative, communication (written and verbal), negotiating, persuasion/influencing, consensus building, time management and presentation skills.</li> <li>Ability to author and deliver engaging presentations that produce and influence results; adept at adjusting communications and approach to various audiences.</li> <li>Ability to analyze data, determine root cause and provide and/or develop solutions; translates that data into actionable/informative presentations.</li> <li>Ability to drive to results; maintains constant awareness of projects and clients and keeps team focused on short- and long-term milestones.</li> </ul> Required: <ul> <li>Bachelor’s degree.</li> <li>Minimum of 10 years of relevant experience.</li> <li>Limited sponsorship may be available.</li> <li>Ability to travel 10-15%, on average, based on the work you do and the clients and industries/sectors you serve.</li> </ul> Preferred: <ul> <li>Professional experience or background in AI, machine learning, or natural language processing.</li> <li>Certified Records Manager (CRM) and/or Project Management Professional (PMP) or Contract Management-related certification.</li> </ul> The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $107,700 to $198,400. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Information for applicants with a need for accommodation: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> EA_ExpHire Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our diverse, equitable, and inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-inclusion.html" target="_blank">Learn more about our inclusive culture.</a> Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Senior Manager: Records & Contracts Compliance & Reporting

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 Summary<ul> <li>Develops Network database tools that enable network management to work more efficiently and focus efforts effectively.</li> <li>Advises on provider performance, network adequacy, geographical coverage, and makes necessary network modifications or expansions.</li> <li>Implements improvement initiatives to ensure that network databases meet all applicable regulatory and quality standards.</li> <li>Conducts market analysis, assesses competitive positioning, and recommends strategies to maintain a competitive edge.</li> <li>Consults with internal teams, including medical directors, operations managers, and network development professionals, to align provider network performance goals and objectives.</li> <li>Provides continuous recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.</li> </ul> Required Qualifications<ul> <li>A minimum of 5 years of SQL and QuickBase (developing and building of dashboards), Python, SAS, Access, Excel, Salesforce, and/or other large data management tools.</li> <li>Adept at machine learning and AI</li> <li>Adept at managing large amounts of data</li> <li>Adept at project management</li> <li>Adept at problem solving and decision-making skills</li> <li>Adept at collaboration and teamwork</li> <li>Adept at Growth Mindset with Mentorship Capability</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> <li>Adept at business intelligence (data driven insights)</li> <li>Intrinsically Driven</li> <li>Proactive Initiator</li> </ul> Preferred Qualifications<ul> <li>Prior Relevant Work Experience with a health system or large payor.</li> <li>Adept at Google Cloud/Desktop</li> </ul> Education<ul><li>Bachelor's degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/17/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr. Network Management Manager - QuickBase

<h3> Position Summary </h3> NetSuite Implementation Senior Consultant Digital Customer is collaborating with clients in ways never thought possible before. We are creating, developing, designing and implementing in ways that will change the digital landscape forever. Our Digital Customer strategy is to help clients define strategies, build brands, create experiences, and deliver platforms. Recruiting for this role ends on 10/19/24. Work you’ll do A Senior Consultant at Deloitte works within an engagement team and is responsible for identifying business requirements, requirements management, functional design, prototyping, process design (including scenario design, flow mapping), testing, training, defining support procedures, leading work streams and supporting implementations. Implement and deploy NetSuite solutions: <ul> <li>Working within an engagement team, a Senior NetSuite Consultant is responsible for identifying business requirements, requirements management, functional design, prototyping, process design (including scenario design, flow mapping), testing, training, defining support procedures, leading work streams and supporting implementations</li> <li>Provide NetSuite consulting expertise utilizing industry experience, business analysis, best practices and a pragmatic mindset to facilitate clients’ most complex requirements.</li> <li>Implement and deploy NetSuite solutions accommodating unique industry business and management processes, regulatory requirements and other business requirements.</li> <li>Create functional requirements as an input to application design.</li> <li>Build, develop and test detailed functional designs for business solution components and prototypes.</li> <li>Drive test planning, execution, and optimization support.</li> <li>Conduct business process mapping and requirements gathering sessions with new customers to determine configuration requirements both on-site and remote.</li> <li>Prepare Business Requirements and Technical Scoping Documents resulting from the above noted mapping sessions to provide proposed solutions for the requirements for customer approval.</li> <li>Build, develop and test detailed scripted customized solutions and prototypes.</li> <li>Troubleshoot issues that arise during configuration sessions.</li> <li>Provide on-going post implementation support to optimize user adoption and NetSuite configuration.</li> </ul> The team Digital Customer Our Digital Customer team focuses on designing and implementing sales and service experiences, capabilities, and architectures to bring customer strategies to life. Our ambition is to be the best in the world at driving customer transformation through the development of clever commercial strategies, distinctive experiences, and the application of digital technologies. We help make the “creative digital consultancy” real and in doing so, make new markets. Professionals will serve our clients through the following types of work: <ul> <li> Customer Operations | modernize, deploy, and operate office capabilities and business processes across sales operations, quote-to-cash, and revenue management team</li> <li> Sales Excellence &amp; Service Excellence | Integrate the latest technologies with leading-edge strategies, insights, experiences, and talent to enable outstanding customer service</li> <li> Salesforce | Deloitte unleashes the powerful Salesforce platform for our clients to drive the best possible outcomes and redefine engagement. We innovate like never before by creatively using technology to help enhance digital customer and employee experiences for our clients.</li> </ul> Qualifications Required <ul> <li>Bachelor's Degree or equivalent experience</li> <li>3+ years of relevant consulting or industry experience</li> <li>2+ years of experience with NetSuite ERP implementations</li> <li>Ability to travel up to 50% on average, based on the work you do and the clients and industries/sectors you serve</li> <li>Limited immigration sponsorship may be available </li> </ul> Preferred <ul> <li>Experience with NetSuite integrations and customizations</li> <li>A Certified NetSuite Professional</li> <li>Experience with full life cycle NetSuite implementations</li> <li>Bachelor's or Advanced degree in accounting, business, finance or other business-related field, computer science, information systems, or other technology-related field</li> </ul> Information for applicants with a need for accommodation: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $131,175 to $218,625. You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. #Customer_US #SS_US Requisition code: 182569 Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our diverse, equitable, and inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-inclusion.html" target="_blank">Learn more about our inclusive culture.</a> Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

NetSuite Implementation Senior 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 SummaryReporting to the Lead Director of Medicaid Revenue Integrity, the Senior Manager will work closely with various Revenue Integrity Lead Directors and subject matter experts across the Medicaid business to establish and champion market level revenue integrity excellence. This position is responsible for supporting all assigned market level risk adjustment activities and processes related to complete and accurate diagnosis capture through provider and member engagement. In support of the Revenue Integrity Medicaid Performance Management Office (PMO) this position will lead the work and deliverables of multiple complex projects, focusing on process improvement, production, and data analysis. This individual should have proven project management of multiple complex projects simultaneously and demonstrate understanding of root cause analysis. This position may act as a liaison with other key business areas, internally and externally. The Medicaid Revenue Integrity Senior Manager will play a critical role in extracting, analyzing, and interpreting healthcare and financial data from multiple sources to address business opportunities regarding population health management, health and economic outcomes, and other business needs. Required Qualifications<ul> <li>5+ years of data analytics experience in healthcare environment or equivalent work environment</li> <li>5+ years of Project Management experience managing multiple projects simultaneously and meeting deadlines.</li> <li>2+ years of leadership experience</li> <li>Strong analytical and problem-solving skills</li> <li>Proficiency in Microsoft suite and data visualization tools (i.e. Excel, PowerPoint, Tableau etc)</li> <li>Excellent communication, presentation/creating presentations, and writing skills.</li> <li>Highly organized with excellent attention to detail</li> </ul> Preferred Qualifications<ul> <li>Knowledge of Risk Adjustment, preferably Medicaid</li> <li>Detail-oriented with a disposition to probe into technical details for accuracy and completeness</li> <li>Design and code efficiently in SQL, SAS, or similar programming language</li> </ul> Education Bachelor's Degree or equivalent work experience Pay RangeThe typical pay range for this role is:$67,900.00 - $182,549.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/16/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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