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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 SummaryMultifunctional project manager who will use critical thinking skills to support the Commercial, Medicare, Duals and Medicaid policy and procedure review process; develop and implement strategies to support UM transformation activities and manage desktops, job aids, tools and resources. This position is part of the UM COE, Program Design &amp; Implementation team that is responsible Clinical Services utilization management and specialty program policies &amp; procedures. Primary responsibilities of this position include: the support of Commercial, Medicare, and Medicaid policies and Medicaid state amendments, Duals policies, drafting/leading the implementation of changes that impact workflows that clinical teams use; support of the UM organization (precertification, predetermination, acute inpatient and post-acute inpatient review) through the development and maintenance of workflows, tools and supporting materials.Responsibilities include the management commercial, Medicare and Medicaid desktops, job aids and documentation templates. The development of tools and resources to support existing and newly designed processes/program changes. The ability to identify efficiencies, respond to field inquiries and project manage process changes including ensuring that all project deliverables and due dates are met while focusing on quality are all components of this position. Must be able to address system interface, accrediting body requirements and collaborate across appropriate organizations during the design of newly identified processes. Support of system enhancements. The ability to conceptualize changes and contribute to system projects that impact UM staff is critical. Must be able to represent the team during project discussions. Serves as a subject matter expert during cross-functional project implementations.The candidate must have excellent communication skills as this position requires verbal presentations and writing of policy/process documents. Some experience in giving verbal presentations and formal writing would be ideal. Requires extensive collaboration with all levels of UM staff from Medical Directors to front line staff thus, management experience is critical. Project management experience preferred. Ideally, the candidate will have led project teams to implementation but, if not, project participation and meeting assigned project deliverables is sufficient. Required Qualifications3 years minimum of utilization management experience required Preferred Qualifications Project Management Certification, preferred3 years minimum of supervisory experience required EducationThe minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $119,340.00This 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: 03/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Health Service Manager

<h3> Position Summary </h3> Position Summary As a GenAI Engineer Specialist, you will be the visionary and driving force behind our GenAI strategy, roadmap, and implementation. Your role will encompass all aspects that are necessary to make GenAI part of everything we do: how we build products (GenAI-powered SDLC activities) and what we build (GenAI infusion into features &amp; functionalities). You will get to be hands-on most of the time and will lead by example, act as role model, actively engaging in high-visibility projects while mentoring and guiding engineers. This role demands a deep understanding of AI/ML/GenAI technologies, leadership acumen, and a passion for driving innovation. The ideal candidate will lead engineers and collaborate with cross-functional teams to design, develop, and deploy advanced AI/ML/GenAI solutions. Work you’ll do * Strategic Vision and Alignment: Craft and articulate a vision for GenAI as it specifically applies to the product engineering teams in alignment with the US Deloitte Technology GenAI strategy. Collaborate with diverse stakeholders, including product, engineering, experience, delivery, security, and infrastructure teams. * Advocacy and Technology Roadmap: Advocate for, develop, and communicate the GenAI implementation approach to the product engineering teams. Ensure the organization is well-informed about objectives, KPIs, technology roadmaps, and progress. * Craft Mastery and Objectives Realization: Define, measure, and drive the achievement of KPIs. Establish and evolve AI/ML/GenAI domain standards and best practices. Actively be hands-on with design, architecture, and code most of the time, contributing to team velocity, and be actively engaged with engineers across SSDLC. Review code, drive tech debt reduction, and experiment with new tech. * Capability Evolution and Development: Mentor and develop engineers. Coach and develop skills in modern engineering practices, related to AI/ML/GenAI. Showcase learning and mastery by showcasing experiments internally, speaking at conferences, writing whitepapers or blogs, and leading R&amp;D collaborations. * Iterative Value Delivery: Embrace an iterative/incremental approach to product engineering. Apply a learning-forward approach to navigate complexity and uncertainty. Ensure alignment with customer and business goals through iterative steps and empirical evidence. * Customer-Centric Problem Solving: Focus on addressing critical issues faced by customers and users. Align technical solutions with business objectives. Minimize unnecessary technical complexities and overengineering. Drive teams toward peak performance through continuous learning and improvement. * Expert Proficiency and Continuous Improvement: Possess deep expertise in modern software engineering practices. Identify inefficiencies and opportunities for innovation. Enhance the product engineering operating model to be lean and adaptable. Guide and transform the organization to embrace lean principles and foster a culture of innovation. * Tech/Quality Risk Management: Ensure appropriate technology use and adoption by engineers. Develop and implement explainable, scalable, reliable, and secure products. Inspire experimentation and quality of code. Identify potential technical risks and develop mitigation strategies. * Influential Communication: Influence, persuade, and drive decision-making processes. Communicate effectively in both written and verbal forms. Craft clear, structured arguments and technical trade-offs supported by evidence. * Organizational Engagement and Collaboration: Engage stakeholders at all levels of the organization. Build collaborative and constructive relationships. Co-create and drive momentum and value across multiple organizational levels. The team Deloitte Technology US (DT - US) helps power Deloitte’s success, which serves many of the world’s largest, most respected organizations. We develop and deploy cutting-edge internal and go-to-market solutions that help Deloitte operate effectively and lead in the market. Our reputation is built on a tradition of delivering with excellence. The ~3,000 professionals in DT - US deliver services including: * Cyber Security * Technology Support * Technology &amp; Infrastructure * Applications * Relationship Management * Strategy &amp; Communications * Project Management * Financials Deloitte Product &amp; Engineering US Deloitte Technology Product Engineering has modernized software and product delivery, creating a scalable, cost-effective model that focuses on value/outcomes that leverages a progressive and responsive talent structure. As Deloitte’s primary internal development team, Product Engineering delivers innovative digital solutions to businesses, service lines, and internal operations with proven bottom-line results and outcomes. It helps power Deloitte’s success. It is the engine that drives Deloitte, serving many of the world’s largest, most respected companies. We develop and deploy cutting-edge internal and go-to-market solutions that help Deloitte operate effectively and lead in the market. Our reputation is built on a tradition of delivering with excellence. Qualifications Required: * Bachelor’s degree or equivalent experience in computer science, software engineering, or a related field. * Minimum 10 years of modern software engineering experience * Minimum 5 years of hands-on applied experience in AI/ML * Minimum 5 years of experience with cloud hyper-scalers like AWS, Azure, GCP to build cloud-native applications * Minimum 2 years focused on GenAI as well as technologies like OpenAI, Claude, Gemini, LangChain, Agents, Vector databases, and approaches like prompt engineering, fine-tuning, etc. * Limited sponsorship may be available * Recruiting for this role will end on April, 1st 2025 Preferred: * 12 years of hands-on applied experience in AI/ML * Prior experience in modern software engineering practices, including Agile methodologies, DevSecOps, SRE, MLOps, deployment techniques like Blue-Green, Canary to enable A/B testing approaches. * Prior experience in: Python, R, TensorFlow, PyTorch, Keras, C#, Julia, ML libraries, NLP, NodeJS, Javascript, Streamlit, etc. * Prior experience in managing big data of various forms to generate insights and create intelligence. * Prior experience of leading and managing high-performing engineering teams. * Advanced degree (e.g., MS) in computer science, software engineering, or related field. 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 $125,000 to $ 220,000. How you’ll grow At Deloitte, our professional development plan focuses on helping people at every level of their career to help them to identify and use their strengths to do their best work every day. From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to help sharpen skills in addition to hands-on experience in the global, fast-changing business world. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career. Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. [1] Learn more about what working at Deloitte can mean for you. Deloitte’s culture Our positive and supportive culture encourages our people to do their best work every day. We celebrate individuals by recognizing their uniqueness and offering them the flexibility to make daily choices that can help them to be healthy, centered, confident, and aware. We offer well-being programs and are continuously looking for new ways to maintain a culture where our people excel and lead healthy, happy lives. [2] Learn more about Life at Deloitte. Corporate citizenship Deloitte is led by a purpose: to make an impact that matters. This purpose defines who we are and extends to relationships with our clients, our people and our communities. We believe that business has the power to inspire and transform. We focus on education, giving, skill-based volunteerism, and leadership to help drive positive social impact in our communities. [3] Learn more about Deloitte’s impact on the world. Recruiter tips We want job seekers exploring opportunities at Deloitte to feel prepared and confident. To help you with your interview, we suggest that you do your research: know some background about the organization and the business area you’re applying to. [4] Check out recruiting tips from Deloitte professionals. 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

Sr. Mgr, GenAI Lead Engineer, Application Development

<h2>DESCRIPTION</h2> Amazon's Perfect Order Experience team works to ensure that buyers receive authentic products in the condition and with the functionality they are expecting. We design and implement policies, tools, and technology innovations to protect the buying experience on Amazon. Our greatest challenge is protecting buyer trust without unjustly harming good selling partners. To strike the right balance, we invest in mechanisms which allow us to accurately identify and mitigate risk, and to quickly correct and learn from our mistakes. This strategy includes continuously evolving enforcement policies, iterating our Machine Learning risk models, and exercising high‐judgement decision‐making where we cannot apply automation. As a successful candidate you will have the opportunity to participate in risk assessments of new products and services, as well of our existing processes and systems. You will identify opportunities to improve our processes and controls to mitigate risk and improve operational performance. You will also contribute to the development of risk mechanisms to help the business identify and evaluate internal/external risks, and help define the technology, processes, and control improvements required to mitigate them. You will work with business, operations, and technology teams to help them manage risks to their business, while influencing the broader risk culture across Amazon’s Perfect Order Experience organization. You will also engage with stakeholders across the company, including other specialized fraud, risk, compliance, and legal functions. This position supports a global organization and is an exciting opportunity to be a part of a dynamic and high paced environment. You must be comfortable with balancing strategic thinking with tactical, detailed execution while working independently, sorting through ambiguously defined problems, identifying and facing big challenges and adjusting to sudden and frequent change. The right candidate is someone who thinks big, understands risks and enjoys innovating brand new controls/solutions to mitigate risks. - Perform risk assessments for new products/features and existing processes/systems to surface risks across all risk categories (i.e. operational, strategic, reputational, etc.), engaging SMEs as needed. - Implement risk mitigation strategies and control mechanisms to prevent fraud, abuse, and other operational risks that negatively impact Amazon, our partners, and our customers. - Support risk reporting, as well as oversight and escalation mechanisms, to ensure key risks are addressed prior to launch through mitigation or risk acceptance at appropriate levels. - Perform post-launch reviews to capture new risk scenarios; conduct deep dives on repeated errors to eliminate defects - Audit and analyze risk metrics for each business to identify emerging risks and monitor controls. - Prepare and deliver business reviews to the management team regarding emerging risks, status of risk assessments, and control performance. - Contribute to management reviews regarding project progress and roadblocks. - Surface risk insights and best practices for risk management and mitigation. - Contribute to internal risk management tools, resources, training, and mechanisms that can scale with the organization. - Independently manage projects as assigned. - Work closely with stakeholders within Customer and Brand Trust by communicating appropriately to process owners and management during and at the conclusion of project. - Ability to manage multiple competing priorities. - Ability to prioritize in an ambiguous environment. - Adept at being a change agent by bringing solutions/ideas to tackle any challenge. About the team Here at Selling Partner Services, we embrace our differences. We are committed to furthering our culture of inclusion. We have 14 employee-led affinity groups, reaching 10,000+ employees in chapters globally. We have innovative benefit offerings, and we host annual and ongoing learning experiences, including our DEI Ambassador Program. Amazon’s culture of inclusion is reinforced within our 16 Leadership Principles, which remind team members to seek diverse perspectives, learn and be curious, and earn trust. <h2>BASIC QUALIFICATIONS</h2> - 4+ years of compliance program management, legal, governance, audit, risk/loss prevention, or equivalent experience - Bachelor's degree or equivalent - Experience handling confidential information - Exceptional written communication skills - able to write, clearly and succinctly. - Exceptional ownership and bias for action – willing to move quickly and decisively to resolve an incident. - Strong critical thinker with the vision to work both tactically and strategically. - Proven analytical thinking with a natural tendency to use data in decision-making and prioritization. - Excellent cross departmental collaboration skills. <h2>PREFERRED QUALIFICATIONS</h2> - 3+ years of program requirements definition and data and metrics leveraging to drive improvements experience - Professional auditing qualification, or similar risk or compliance credentials - Experience with SQL and Excel - Experience working in risk, fraud or compliance organizations. - High level of integrity and discretion to handle confidential information. - Strong enthusiasm to provide superb customer service to executive leadership and other key stakeholders. - Proven ability to bring clarity to ambiguous situation. - Demonstrated analytical and quantitative skills to use hard data and metrics to back up assumptions Amazon is committed to a diverse and inclusive workplace. Amazon is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. For individuals with disabilities who would like to request an accommodation, please visit <a href="https://www.amazon.jobs/en/disability/us" target="_blank">https://www.amazon.jobs/en/disability/us</a>. Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $66,800/year in our lowest geographic market up to $142,800/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. Amazon is a total compensation company. Dependent on the position offered, equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, financial, and/or other benefits. For more information, please visit <a href="https://www.aboutamazon.com/workplace/employee-benefits" target="_blank">https://www.aboutamazon.com/workplace/employee-benefits</a>. This position will remain posted until filled. Applicants should apply via our internal or external career site.

Amazon

Risk Manager II

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 Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a remote based (work from home) position. Preferred candidates will have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical policy implementation. You will support the Medical Management staff ensuring timely and consistent responses to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited Appeals / Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and clinical liaison to network providers and facilities if needed, to support the effective execution of medical services programs by the clinical teams. Required Qualifications *Two (2) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Prior UM (Utilization Management) experience *Active and current state medical license without encumbrances *M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience. Preferred QualificationsActive and current state medical license in CA without encumbrances and willing to obtain an AZ medical license. Internal Medicine background Have experience in Medicare and Medicaid Education*M.D. or D.O., Board Certification in an ABMS or AOA recognized specialty including post-graduate direct patient care experience.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: 02/28/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director - Commercial Appeals

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. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Position Purpose: Supports the Medicare Communications Compliance team in the management of regulatory requirements associated with the Medicare materials and sales compliance. Participates in the ongoing oversight, analysis, review, and approval of all beneficiary-facing Medicare materials. In addition, may also support the department with special projects.<ul> <li>Conducts review of difficult or detailed member and prospective member communications against regulations to ensure compliance.</li> <li>Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes with the Medicare Marketing Guidelines and relevance on material review.</li> <li>Provides project leadership, including the review of departmental documents, summarizing results, and implementing recommendations.</li> <li>Provides mentoring or coaching to specialists or operational business partners on review of materials.</li> <li>Assists department management with review of new or updated regulations.</li> <li>Performs other duties as assigned.</li> <li>Complies with all policies and standards.</li> </ul>Education/Experience:<ul> <li>Bachelor’s degree in Health Administration, related field, or equivalent experience required.</li> <li>5+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required.</li> <li>Some experience in State or Federal managed care compliance and project coordination required.</li> </ul>Pay Range: $68,700.00 - $123,700.00 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

Oklahoma Complete Health

Senior Medicare Communications Compliance 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 Summary<ul> <li>Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex, market/regional/national based group/system providers including but not limited to individual and group behavioral health providers, etc. in accordance with company standards in order to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives.</li> <li>Recruit providers as needed to ensure attainment of network expansion goals, achieve regulatory and/or internal adequacy targets.</li> <li>Support health plan with expansion initiatives or other contracting activities as needed</li> <li>Initiates, coordinates and owns contracting activities to fulfillment including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to Aetna’s established policies.</li> <li>Responsible for building, and loading contracts, agreements, amendments, and/or fee schedules in contract management systems per Aetna established policies.</li> <li>Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities.</li> <li>Provides Subject Matter Expertise for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained.</li> <li>Engage with providers and move quickly through contracting processes to ensure network adequacy standards are met.</li> </ul>Required Qualifications<ul> <li>3-5 years of network contracting/management experience.</li> <li>3-5 years of solid negotiating and complex decision-making skills while executing national, regional, or market level strategies.</li> <li>In-depth knowledge of the managed care industry and practices.</li> <li>Working knowledge of behavioral health topics related to managed care plans.</li> <li>Detail-oriented with strong communication, analytical and negotiation skills.</li> <li>Ability to build collaborative relationships with providers work cross-functionally to resolve complex provider contract issues</li> <li>Demonstrated high proficiency with MS Office suite applications (e.g., Outlook, Word, Excel, etc.)</li> <li>Ability to work remote in Central time zone</li> </ul> Preferred Qualifications<ul> <li>Health plan experience supporting behavioral health provider networks.</li> <li>General knowledge of reporting tools for contract financial analysis and modeling.</li> <li>Solid decision-making skills while executing national, regional and market level strategies.</li> <li>Possess critical thinking, issue resolution and interpersonal skills.</li> <li>Strong communication skills (written, verbal and presentation).</li> <li>Highly organized and self-driven.</li> <li>Contract negotiations experience in the Colorado market</li> </ul> Education Bachelor's degree desired or equivalent work experience.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$54,300.00 - $145,860.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Mgr,Contract Negotiation - Behavioral Health

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 SummaryLeads and oversees the planning, execution, and successful completion of project workstreams to support all activities of determined pharmacy network disruption, including but not limited to:defining network disruption project scope, workplan objectives, deliverables and timelines, task ownership and development, and managing project budgets and resources if deemed essential. Coordinates and utilizes all necessary pharmacy network data and analytics to support a project plan. Collaborates with all required cross-functional teams, communicates project progress to stakeholders, and mitigates identified risks to deliver projects on time ensuring quality service standards to clients, members, and pharmacy network. Preferred strong understanding of pharmacy network structure, set-up, strategy, and impact to plan sponsors and their members.Responsibilities will include:<ul> <li>Alignment of pharmacy network contracting cycles and timelines to determine when potential pharmacy network disruption event would be precipitated. </li> <li>Management and initiation of pharmacy network disruption activities to align all required efforts supporting plan sponsors and affected members.</li> <li>Owns and manages a comprehensive playbook of project plans and various workstreams leading other stakeholders to identify, implement, and execute effective strategies to minimize member and client impact.</li> <li>Consolidates information from various sources, synthesizing pharmacy network project data and insights to provide comprehensive reports and updates to stakeholders.</li> <li>Allocates accountability by determining and assigning clear responsibilities and expectations to project team members, ensuring effective project execution.</li> <li>Analyzes the project management practices, identifying areas of risk and implementing mitigation strategies to enhance project outcomes and success.</li> <li>Presents project plans and deliverables, ensuring alignment with organizational objectives, leadership, and stakeholder expectations.</li> <li>Initiates project meetings and collaborates with multiple departments, fostering cross functional collaboration and coordination to achieve project milestones.</li> <li>Communicates direction and project goals to the project team, providing clear guidance and ensuring alignment with strategic objectives.</li> <li>Conducts project evaluations and assessments, monitoring progress, identifying risks and issues, and taking corrective actions to keep projects on track.</li> <li>Counsels and mentors’ staff and project team members providing guidance, support, and coaching to enhance their skills and performance in pharmacy network project management.</li> </ul> Required Qualifications<ul><li>7+ years of experience in Project management, Change Management, or similar role.</li></ul>Preferred Qualifications<ul> <li>3+ years project leadership and management experience</li> <li>PBM experience preferred.</li> <li>Adept at project execution and delivery (planning, delivering, and supporting) skills.</li> <li>Adept at collaboration and teamwork</li> <li>Mastery of problem solving and decision-making skills</li> <li>Proven thought leader to identify and communicate project plan deviations, setbacks, or other related impacts</li> <li>Self-starter who can identify opportunities, take action with minimal prompting and influence beyond immediate scope of responsibility</li> <li>Strong understanding of pharmacy network structure, set-up, strategy, and impact to plan sponsors and their members.</li> </ul> EducationBachelor's degree preferred, specialized training, or relevant professional qualifications.Pay 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: 04/16/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Manager, Pharmacy Network Disruption Management

Current Saint Francis Employees - Please click <a href="http://www.myworkday.com/saintfrancis/d/task/3005$4482.htmld" target="_blank">HERE</a> to login and apply. Full TimeJob Summary: The Pro Fee Coding Specialist performs diagnosis and/or procedural coding as assigned in order to apply the appropriate diagnosis and procedural codes to individual patient health information for data retrieval, analysis, and claims processing. Minimum Education: Commensurate education with achieving qualifications to sit for Certification Exam(s) as related to ICD-10, CPT and other related specialty certifications. Licensure, Registration and/or Certification: Certified Coder through AAPC, AHIMA, BCHH-C, HCCS for Home Health or National Healthcare Association. Applicants who have not yet achieved a coding certification may be considered when work experience is at least two years. The applicant will need to obtain the certification within one year of hire. Work Experience: 0 - 2 years related experience including a demonstrated thorough understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. Requires experience and/or training in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded. Knowledge, Skills and Abilities: Basic computer and encoder skills. Effective interpersonal, oral and written communication skills. Ability to organize and prioritize work in an efficient and effective manner. Uses good judgment when determining whether a record is complete enough to code or should be held for more documentation. Ability and requires maintaining continuing education credits for credentialed coders, stays updated on coding rules, attends seminars and reviews and coding periodicals. Ability to be cooperative, dependable and responsive to the changing nature of the coding workflow. Ability to be flexible when asked to do different assignments. Essential Functions and Responsibilities: Codes as assigned from review of medical record documentation. Applies knowledge of current coding and billing requirements to assure claims are submitted correctly. Monitors coding and billing performance and resolves denials related to coding errors. Performs review for charge corrections and rebilling as required for resolution of coding denials. Develops preventative measures in response to patterns identified through analysis of claims denial data; prepares periodic reports for clinical staff, identifying corrective measures to resolve denial problems. Advises and instructs providers regarding documentation and billing policies, procedures and regulations; interacts with providers regarding conflicting, ambiguous or none-specific documentation, obtaining clarification of same. Educates provides and office staff regarding documentation coding and billing changes and regulations to assure compliance with local, state and national policies. Works collaboratively with providers, office staff, billing personnel, quality department and compliance, and coding resources to ensure accurate coding. Decision Making: Independent judgment in planning sequence of operations and making minor decisions in a complex technical or professional field. Working Relationships: Works with internal customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Special Job Dimensions: None.Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.Health Information Ambulatory Coding - Yale CampusLocation:Virtual Office, Oklahoma 73105EOE Protected Veterans/Disability

Saint Francis Health System

Pro Fee Coding Specialist

<h3> Position Summary </h3> The Human Capital Offering Portfolio focuses on helping organizations manage and sustain their performance through their most important asset: their people. Centered on five core issues, this Portfolio signifies to the market that we see Human Capital as a topic critical to the C-Suite. As we go-to-market we will show our clients that we serve more than HR organizations - from the CEO to CFO, Risk Manager to Business Unit leader—and that we deliver on our issues and help create value for our clients. The Team - Organization Transformation A part of Deloitte Consulting LLP, our Organization Transformation professionals work closely with clients around the world to develop effective and efficient people-centered solutions. Our team helps clients define their strategy and align it with their executive business vision using innovative strategic frameworks that enhance HR service delivery models, set the stage for continuously improving operational excellence, and reimagines the HR brand. Recruiting for this role ends on 5/2/2025. Work you’ll do As a Deloitte Consulting Retirement &amp; Wealth Provider Solutions Senior Consultant, you will help Retirement Service Providers gain competitive advantages and differentiate themselves in the areas of business strategy, sales and marketing, client service, product development, technology, and business operations. You will also work in conjunction with other practitioners to on the following: <ul> <li>Analyze and benchmark client’s existing products and services for market competitiveness, strengths, deficiencies and gaps</li> <li>Develop differentiation strategies and improvement recommendations</li> <li>Train clients on marketplace trends including conducting market research studies and developing white papers</li> <li>Develop strategies for providers to increase their competitiveness through differentiation of products, processes, and/or services</li> <li>Develop products and services for providers</li> <li>Advise on and implement business and technology transformation</li> <li>Research marketplace to support project deliverables</li> <li>Create detailed client deliverables that support findings and recommendations</li> <li>Ability to reach out to Retirement Services network to gather trends</li> <li>Act in a mentoring capacity to support the career development of retirement provider colleague</li> </ul> Required Qualifications: <ul> <li>Bachelor's degree</li> <li>Minimum four (4) years of relevant experience with demonstrated knowledge of retirement products and services, and retirement market trends developed through professional experiences</li> <li>Experience leading and mentoring project teams on relevant engagements</li> <li>Ability to travel 0-50%, 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 Qualifications: <ul> <li>External strategy &amp; management consulting experience within a large organization</li> <li>Advanced degree in related specialization area</li> <li>Desire and eagerness to mentor and assist in the professional development of junior staff members</li> <li>Previous consulting experience</li> <li>Exposure to business development in related specialty areas (i.e. proposal development, sales, etc.)</li> <li>Demonstrated interest in a profession in benefits administration &amp; outsourcing through professional organizations, coursework, certifications, conference attendance, etc.</li> <li>Strong oral and written communication skills, including presentation skills (MS Visio, MS PowerPoint, MS Word)</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> 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 $137,700 to $229,500. 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-human-capital-consulting-jobs.html</a> #HC25 #OT25 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.

Retirement & Wealth Provider Solutions 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.We are seeking a highly skilled and strategic Sr. Manager to join our team at CVS Caremark. This role will be pivotal in collaborating with our underwriting organization to develop and implement innovative pricing strategies that drive value for our organization and our clients. The ideal candidate will possess a deep understanding of pricing models, market dynamics, and the ability to analyze data to inform strategic decisions.Position Summary Provides strategic direction in support of the organization's business goals and financial integrity. Collaborates with business partners to provide sound risk management advice.<ul> <li> Strategic Development: Lead the development of pricing strategies that align with CVS Caremark’s overall business objectives and market positioning. Identify opportunities for innovative pricing approaches that enhance profitability and competitiveness.</li> <li> Collaboration with Underwriting: Work closely with the underwriting team to develop and integrate pricing strategies that reflect the organization’s objectives.</li> <li> Market Analysis: Work with our business partners to identify trends and opportunities for differentiation. Utilize insights to inform pricing decisions and strategies.</li> <li> Data-Driven Decision Making: Leverage data analytics to assess UW assumptions setting </li> <li>the effectiveness of pricing strategies and make informed recommendations for adjustments. Monitor key performance indicators (KPIs) to evaluate the impact of pricing initiatives.</li> <li> Pricing Model Innovation: Develop and implement new pricing models that drive value for both CVS Caremark and its clients.</li> <li> Cross-Functional Leadership: Collaborate with various departments, including sales, marketing, finance, and operations, to ensure alignment and support for pricing strategies. Facilitate communication and knowledge sharing across teams.</li> <li> Stakeholder Engagement: Present pricing strategies and recommendations to senior leadership and key stakeholders. Build strong relationships with internal partners to foster collaboration and support for pricing initiatives.</li> <li> Regulatory Compliance: Ensure that all pricing strategies comply with relevant regulations and industry standards. Stay informed about changes in the regulatory landscape that may impact pricing.</li> </ul>Required Qualifications<ul><li>7+ years’ experience in analytics or actuary role within the PBM.</li></ul>Preferred Qualifications<ul> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> <li>Adept at business intelligence</li> <li>Adept at collaboration and teamwork</li> <li>Mastery of problem solving and decision making skills</li> <li>Mastery of growth mindset (agility and developing yourself and others) skills</li> </ul>Education<ul><li>Bachelor's degree or relevant work experience.</li></ul>Pay RangeThe typical pay range for this role is:$106,605.00 - $284,280.00 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: 04/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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