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<h3> Position Summary </h3> Learning and Development (L&amp;D) Project Lead Specialist The Talent Innovation and Solutions Digital &amp; Analytics team implements and supports core, firmwide Talent applications leveraged to support key Talent strategies and processes. As Talent identifies opportunities to transform the way we deliver services, technology solutions will need to be implemented or updated to provide an enhanced experience to our professionals and to drive operational efficiency and effectiveness improvements across Talent. We are seeking a motivated and organized team member to join our team, focusing on Talent project activities and systems that are part of the Growth &amp; Development portfolio. As a Lead Specialist, you will directly support and manage various aspects of planning and deploying technical programs and projects across multiple client projects/engagements. You will ensure the successful implementation of vendor and/or custom solutions, adhering to project timelines and budget constraints. Additionally, you will provide strategic direction and business guidance to Talent stakeholders and technical teams, while supervising and coordinating team efforts to execute project plans throughout the program or project lifecycle. Recruiting for this role ends on March 14th, 2025. Work you’ll do As the our Lead Specialist, you will: <ul> <li> Project Management: <ul> <li>Lead up to two concurrent project implementations while supporting up to three live systems/projects in post-deployment activities.</li> <li>Plan, schedule, estimate, forecast, coordinate, and manage the delivery of all project deliverables and related initiatives.</li> <li>Define technical requirements for new initiatives/projects, ensuring compliance with firm standards and security protocols.</li> <li>Understand, assess, and review business issues, translating them into technical terminology for discussions with Deloitte Technology and support teams.</li> <li>Monitor and report on the status of project efforts, lead project status activities, and proactively manage project issues and risks (RAID log). Propose recommendations and solutions to resolve potential conflicts and risks.</li> </ul> </li> <li> Training and Documentation: Conduct training sessions on system/project-related topics and collaborate with stakeholders and support teams to update current documentation.</li> <li> PMO Support: Support the Talent Innovation and Solutions Digital &amp; Analytics Manager as the PMO Lead for various operations activities and technology projects as applicable.</li> <li> Resource Management: Utilize shared project team sites, OneNote notebooks, Smartsheet, and mailboxes to ensure structured communication and access to materials and documents for all project team members.</li> </ul> Required Qualifications <ul> <li>Bachelor’s Degree</li> <li>Minimum of 6 years of relevant experience with project management support to implement new Talent systems and processes, from ideation thru deployment</li> <li>Proficient Microsoft Office skills (e.g., PowerPoint, Excel, OneNote, Word, Teams); Knowledge of relevant applications and development life cycles</li> <li>Ability to travel 5%, 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 Qualifications <ul> <li>Knowledge of Learning and Development (L&amp;D) technologies</li> <li>Knowledge of the professional services industry</li> <li>PMP 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 $88,600- $163,100. 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 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

Learning and Development Project Lead Specialist

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryThis is a full-time telehealth role within the US. Must reside in a compact state and hold a compact license. Hours Monday-Friday EST working 3 day shifts and 2 evening shifts a per weekEvening hours end at 9:00 PM EST Rotating 5 hour shifts on Saturdays will be required per business needs approximately quarterlyRotating Friday evening until 9:00 PM EST approximately quarterlyJob Descriptions The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status. - Assessment of Members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. - Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.Enhancement of Medical Appropriateness &amp; Quality of Care: - Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. - Using holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives. - Identifies and escalates quality of care issues through established channels. - Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. - Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. - Interprets and utilizes clinical guidelines/criteria to positively impact members health Provides up-to-date healthcare information to help facilitate the member¡¦s understanding of his/her health status. - Helps member actively and knowledgably participate with their provider in healthcare decision-making.Monitoring, Evaluation and Documentation of Care - Develops and monitors established plans of care, in collaboration with the member and/or attending physician, to meet the member's goals. - Utilizes internal policy and procedure in compliance with regulatory and accreditation guidelines. Required Qualifications - Must have an unrestricted compact license in the state of residence with ability to apply for and obtain additional licenses required per account needs - 3+ years of Adult Medical Surgical experience in a hospital or clinic setting - Must possess/be willing and able to obtain high speed internet access and be hardwired to internet - 1+ years of experience documenting in Electronic Medical Records Preferred Qualifications- Previous telephonic or face to face health coaching experience - Previous Managed Care experience - Experience with Microsoft Word, Outlook, Excel products- Experience using multiple digital applications simultaneously, while conducting assessment interviews and documenting member responses- Experience using Epic EducationAssociate or Bachelor’s degree requiredAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,095.00 - $116,760.00This 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 03/13/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

RN - Registered Nurse - Health Coach Consultant - Chronic Conditions

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryAetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Cardiology) that can be remote based, work from home.This role can be remote based anywhere in the US.The Medical Director (Cardiology) will be a Subject Matter Expert (SME) with a background in Cardiology 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 Cardiology specialty including post-graduate direct patient care experience specifically Preferred Qualifications * Previous healthcare insurance experience. Education * M.D. or D.O.,Board Certification in a Cardiology 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director - (Cardiology)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Recruit physician, hospital and ancillary service providers to sign network participation agreements that are in accordance with Corporate, health plan and State guidelines. Ensure that all necessary documentation and information are included. <ul><li>Recruit and develop network for a region and set of providers</li></ul> <ul><li>Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives</li></ul> <ul><li>Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication</li></ul> <ul><li>Initiate contact and identify potential providers by geographic and specialty needs and update database</li></ul> <ul> <li>Coordinate with internal departments and contracted providers to implement and maintain contract compliance</li> <li>Performs other duties as assigned</li> </ul> <ul><li>Complies with all policies and standards</li></ul>Education/Experience: Bachelor’s degree in Healthcare Administration, Business Administration, Finance, related field or equivalent experience. 0-2 years of contracting, contract analysis, provider relations, or provider experience in a hospital or physician’s office or group setting. Familiarity with State and/or Federal health care programs preferred (Medicaid, Medicare).Pay Range: $55,100.00 - $99,000.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Centene Corporation

Contract Negotiator I

<h3> Position Summary </h3> 191538NetSuite Implementation 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. Work you’ll do A 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>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>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 $97,875 to $163,125. 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: 191538 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 Consultant

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position 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 EST zones Education:<ul> <li>Associate Degree required</li> <li>BSN preferred</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$26.01 - $56.14This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 03/14/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary Utilization 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 CST or EST zones Education Associates Degree required BSN preferred Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$26.01 - $56.14This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 03/11/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Consultant

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.<ul> <li>Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate</li> <li>Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria</li> <li>Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning</li> <li>Analyzes BH member data to improve quality and appropriate utilization of services</li> <li>Provides education to providers members and their families regrading BH utilization process</li> <li>Interacts with BH healthcare providers as appropriate to discuss level of care and/or services</li> <li>Engages with medical directors and leadership to improve the quality and efficiency of care</li> <li>Formulates and presents cases in staffing and integrated rounds</li> <li>Performs other duties as assigned</li> <li>Complies with all policies and standards</li> </ul>Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master’s degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification:<ul> <li>LCSW- License Clinical Social Worker required or</li> <li>LMHC-Licensed Mental Health Counselor required or</li> <li>LPC-Licensed Professional Counselor required or</li> <li>Licensed Marital and Family Therapist (LMFT) required or</li> <li>Licensed Mental Health Professional (LMHP) required or</li> <li>RN - Registered Nurse - State Licensure and/or Compact State Licensure required</li> </ul>Pay Range: $26.50 - $47.59 per hourCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Utilization Review Clinician - Behavioral Health

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryServes as a single point of contact on a client-facing team. Responds to client service requests and issues, including enrollment and billing, commissions, technical support, install/group administration, and all other routine customer service inquiries. Delivers first-call resolution for 90-95% of inquiries by accurately identifying, researching, and resolving issues based on the initial phone call/letter/email from the client.Responds to moderately complex service inquiries and resolves customer concerns within an organized team. Resolves issues without or with limited management intervention. Provides high-quality, customer-focused telephonic service using knowledge of procedures and systems to meet and/or exceed customer satisfaction while educating constituents on Aetna’s policies and programs. Investigates, analyzes, and resolves service requests and issues including, but not limited to enrollment and billing, commissions, technical support, and install/group administration. Coordinates efforts both internally and across departments to successfully resolve service issues. Accurately records telephonic and virtual customer interactions and follow-up. Supports plan administration activities, including case installation, enrollment, plan set-up, eligibility, and billing by working proactively with support areas. Leads resolution of service issues through partnership with functional operations team. Collaborates with colleagues and co-workers to deliver a world class customer experience. Identifies and implements process improvements. Maintains phone quality and performance levels while working on customer-related projects. Takes responsibility for own self-development. Recommends areas where cross training is needed. Understands the team’s performance against measured service goals. Accepts ownership for individual and team results. Performs other related duties as assigned.Required Qualifications Prior call center/customer service experience.Basic computer skillsProficient multitasking (ability to navigate multiple tabs and customer-based interactions).Excellent attendance during training.EducationHigh School Diploma or Equivalent combination of Education and Work HistoryAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 03/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Answer Team Consultant

<h3> Position Summary </h3> Release Train Engineer Senior Manager Deloitte Human Capital The Human Capital Offering Portfolio focuses on helping organizations manage and improve their performance through their most important asset: their people. To stay in front, organizations need to have real-time access to Human Capital insights, experts and innovative technology solutions that are designed to not only drive but sustain and extend organizational performance and engagement. Supporting the products and capabilities of the Human Capital Offering Portfolio, our team is full of passionate, energetic, and multi-talented engineers who are excited about building the world’s greatest personalized and business friendly applications. This role is central to Deloitte’s Human Capital Engineering Team, and will spearhead, plan, coordinate, and deliver a variety of technical projects. Acting as a chapter lead or chief scrum master, you will be responsible for overseeing the team that leads the delivery of many complex technical projects, including project timeline, scope prioritization, cost, dependencies, and performance risks. This person must be an expert in communication, technology project management, understanding the overall product roadmap, technology stack, application suite, business processes and any downstream system and business impacts. They will collaborate with internal and vendor peers, executives, and line of business partners to ensure the success of projects. Recruiting for this role ends on 10/31/2025. Join this team: We are seeking a highly motivated and experienced Release Train Engineer - Senior Manager to Lead our Scrum Master team. This person will help build Human Capital solutions used by the biggest and most influential businesses around the world. Responsibilities: <ul> <li>Oversee status of all Human Capital Software projects and accurately report on that to Senior Leadership</li> <li>Collaborate / Align technical and non-technical team members to translate customer needs into world-class solutions</li> <li>Play a key role in bridging technical and business aspects, ensuring that the scopes are feasible, aligned with technical capabilities' roadmap, market maturity, and targeted towards tangible business values</li> <li>Lead / Coach teams new to Agile / Scrum methodologies</li> <li>Facilitates and coordinates efforts between Product Owner, Portfolio Architects and Development teams.</li> <li>Collaborate with the business to prioritize and define Epics and User Stories</li> <li>Oversee documentation of User Stories and Acceptance criteria in Jira</li> <li>Identify / Manage / Mitigate risks to prevent issues</li> <li>Align / Ensure end-to-end solution success and readiness</li> <li>Work collaboratively to guide new teams thru the forming, storming, and norming phases</li> <li>Provide / Accept continuous feedback in the spirit of continuous improvement</li> <li>Ensure Scrum ceremonies are collaborative, occur on time, and adhere to “best practice”</li> <li>Promote a healthy and sustainable work environment by using teams’ average velocity to properly size Sprints</li> <li>Coordinate cross functionally to remove blockers and manage dependencies</li> <li>Continuously drive execution and accountability</li> <li>Monitor / Communicate solution status of all teams’ projects</li> <li>Determine what’s important and make solution decisions in the absence of clear guidelines or Product Owner participation</li> <li>When needed, do “whatever it takes” to ensure success</li> <li>Experience motivating high performance teams</li> <li>Coaches Scrum Masters on an enterprise level. Responsible to help them stay on schedule following all agile release train processes and procedures.</li> <li>Lead team of approximately 13 Scrum Masters, Business Analysist, and project management office role</li> </ul> Required Qualifications: <ul> <li>Bachelor's degree</li> <li>8+ years of Scrum Master experience</li> <li>8+ years of technical experience managing development teams</li> <li>8+ years of experience in Agile/Scrum</li> <li>8+ years of JIRA/Confluence experience</li> <li>8+ years of familiarity with cloud technologies (AWS, GCP, Azure)</li> <li>6+ years of experience leading cross-functional teams to identify, scope, and build GenAI/Machine Learning solutions</li> <li>8+ years coaching junior level team members</li> <li>8+ years of experience with financial/budget management and complex cost-benefit analysis</li> <li>8+ years of experience prioritizing/managing a Portfolio of related projects</li> <li>Ability to travel 0-25%, 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 Qualifications: <ul> <li>Bachelor’s degree in Computer Science or Engineering</li> <li>Master’s degree in Business</li> <li>PMP or other accredited Project Management certifications</li> <li>5+ years of product building experience</li> <li>5+ years in AI product management methodologies</li> <li>Agile Certifications (CSM; ACP; CSPO; SAFe; LeSS)</li> <li>5+ years of development/coding experience</li> <li>4+ years of GenAI/Machine Learning knowledge</li> <li>5+ years of DevOps awareness</li> <li>5+ years of experience with HRM Systems – SAP, Oracle, SuccessFactors, Workday</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-as…</a> Possible Locations: Atlanta, Austin, Baltimore, Birmingham, Boca Raton, Boise, Boston, Charlotte, Chicago, Cincinnati, Cleveland, Columbus, Costa Mesa, Dallas, Davenport, Dayton, Denver, Des Moines, Detroit, Fort Worth, Fresno, Grand Rapids, Harrisburg, Hartford, Houston, Indianapolis, Jacksonville, Jersey City, Kansas City, Las Vegas, Los Angeles, Louisville, McLean, Memphis, Miami, Midland, Minneapolis, Morristown, Nashville, New Orleans, New York, Philadelphia, Pittsburgh, Portland, Princeton, Raleigh, Richmond, Rochester, Rosslyn, Sacramento, Salt Lake City, San Diego, San Francisco, San Jose, Seattle, St. Louis, Stamford, Tampa, Tempe, Tulsa, Washington DC 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 $159,375- $265,625. 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. For more information about Human Capital, visit our landing page at: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-human-capital-consulting-jobs.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-hu…</a> #HC25 #HCaaS25 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.

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