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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary:The Clinical Pharmacist is an operation-based role that conducts criteria based &amp; clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from CVS Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed.This position is responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership. This includes providing on-the-job (OJT) training, answering questions from front-line colleagues, production support, and providing recommendations/solutions to effectively streamline systems and processes. The Pharmacist will be responsible for maintaining the most current oncology therapy knowledge through self-education.Responsibilities:1.) Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval &amp; denial management processes. 2.) Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.3.) Responsible for assisting front-line colleagues (i.e. Staff Pharmacists, LPN's and Pharmacy Technicians) with oncology process/procedural support by acting as a subject matter expert (SME) and performing any other complex tasks or addressing any escalation cases assigned by leadership.4.) Assist with standard or client specific oncology review process changes as needed. 5.) Assist with writing Work Instructions when needed.6.) Works collaboratively with internal and external business partners to provide solutions for customers, colleagues, and clients.7.) Provide feedback of trends pertinent to oncology reviews.8.) Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.9.) Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.This is a remote role, open to qualified candidates within the United States.Essential Functions: 1. Regular and predictable attendance2. Colleague may be required to work mandatory overtime/extended work week when needed3. Colleague may be required to travel when needed4. Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.5. Adhere to all policies and procedures6. Attend on going training and development meetingsPhysical Requirements:1. Sits at desk for long periods of time (up to 100%)2. Talking on phone for extended periods of time (up to 100%)3. Computer use for extended periods of time (100%)4. Reading a computer screen (up to 100%)5. Light lifting of less than 10 lbsWork EnvironmentColleague is responsible for maintaining a HIPAA-compliant remote workspace. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access. Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)Education: BS in Pharmacy or PharmD requiredBoard Certified Oncology Pharmacist (BCOP) requiredActive, unrestricted pharmacist licensure in state of residence requiredRequired Skills &amp; Other Minimum Required Qualifications: <ul> <li>Licensed Registered Pharmacist</li> <li>Board Certified Oncology Pharmacist (BCOP) required</li> <li>2+ years clinical pharmacist experience, inclusive of prior authorization experience</li> <li>Knowledge of Microsoft Office Suite: Excel and Word required; Access, Outlook, PowerPoint, Visio preferable. Keyboard skills essential.</li> <li>Must be able to multitask and utilize multiple system applications simultaneously.</li> <li>Must be able to utilize available resources independently and provide high quality work.</li> <li>Must demonstrate problem solving ability and attention to detail.</li> <li>Ability to adapt and change with workflow and shifting priorities.</li> <li>Ability to work effectively in a team environment and provide mentorship to non-clinical staff on the PA team.</li> <li>Must possess excellent written, verbal, grammar, and listening communication skills.</li> <li>Must be able to effectively communicate with a diverse customer base (internal and external) in a friendly and confident manner.</li> <li>Ability to maintain confidentiality of PHI (Protected Healthcare Information).</li> </ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$45.43 - $101.54This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/12/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Clinical Pharmacist - Prior Authorization/Oncology (BCOP Required)

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 SummaryAs a Senior Manager of Strategy and Product Management, you will play a key role in executing the organization’s product and strategy initiatives. You will leverage your expertise to drive new product initiatives, enhance existing offerings, and support membership goals. Working closely with cross-functional teams, you will help prioritize the product pipeline, conduct market analyses, and help optimize the product portfolio.What You Will Do<ul> <li>Support the execution of operational, functional, and business targets within the Strategy and Product Management team, ensuring measurable impact.</li> <li>Contribute to the execution of strategic initiatives aligned with the organization’s goals, utilizing project management tools, data analysis, and stakeholder feedback.</li> <li>Collaborate with teams to prioritize and manage the product pipeline, ensuring alignment with business objectives.</li> <li>Conduct ongoing market and competitive analysis to inform key decision-making and positioning strategies.</li> <li>Help refine business needs analysis methods to establish requirements and specifications for processes and systems supporting product initiatives.</li> <li>Monitor and report on key financial performance indicators for the product portfolio to ensure sustained growth and profitability.</li> </ul>What You Will NeedMinimum Requirements<ul> <li>Active, unrestricted pharmacist license in state of residence</li> <li>5+ years of relevant work experience in product management, strategy, or a related field.</li> <li>5+ years pharmacist experience in PBM or Health Plan</li> <li>Strong execution and delivery skills, including planning, implementation, and support.</li> <li>Experience in business intelligence, data-driven decision-making, and analytical problem-solving.</li> <li>Proven ability to collaborate effectively across teams and build strong relationships.</li> <li>Exceptional problem-solving and decision-making skills.</li> <li>Growth mindset with a focus on agility, continuous learning, and development.</li> </ul>Education<ul><li>PharmD is required.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/13/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Manager, Aetna Medical Pharmacy (Pharmacist)

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. Must live in Central or Eastern Time Zone Training Schedule: Mon - Fri 9am-530pm EST Post Training Schedule: Must be available to work 8 hours between 8am-6pm Position Summary 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 SummaryHealth Concierge is the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.<ul> <li>Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, members and providers.</li> <li>Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest.</li> <li>Fully understands the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.</li> <li>Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.</li> <li>Uses customer service threshold framework to make financial decisions to resolve member issues.</li> <li>Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities – Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.).</li> <li>Utilizes all relevant information to effectively influence member engagement.</li> <li>Takes immediate action when confronted with a problem or made aware of a situation.</li> <li>Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate.</li> <li>Identifies member needs beyond the initial inquiry by answering the unasked questions.</li> <li>Resolves issues without or with limited management intervention.</li> <li>Provides education to members to support them in managing their health.</li> <li>Responds quickly to meet customer needs and resolve problems while avoiding over-committing.</li> <li>Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility.</li> <li>Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals.</li> <li>Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded.</li> <li>Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.</li> <li>Partners with other departments to deliver client specific presentations.</li> <li>Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.</li> <li>Works collaboratively with colleagues to deliver the best customer experience Seeks to understand the customer, including circumstances, problems, expectations and needs.</li> <li>Asks probing questions to identify the underlying customer needs.</li> <li>Appropriately transitions conversations to explore possibilities for extending customer interactions.</li> <li>Guides members to the appropriate health resource Offers alternatives where appropriate.</li> <li>Acts with the best interest of customer in mind and central to all interactions.</li> <li>Collaborates with colleagues and co-workers to deliver a world class customer experience.</li> <li>Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters.</li> <li>May participate in preparation and presentation of client specific presentations.</li> <li>May track and trend data.</li> <li>Coaches, trains and assists in the development of call center staff, as required.</li> <li>Participates in and/or leads special projects/initiatives addressing service issues, as necessary.</li> <li>Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed.</li> <li>Delivers internal quality reviews.</li> <li>Provides appropriate support in third party audits when required.</li> <li>Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.</li> </ul> Required Qualifications<ul><li>Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.</li></ul><ul> <li>Effective organizational skills and ability to manage multiple tasks.</li> <li>Effective communication skills, both verbal and written</li> <li>Experience working with computers</li> </ul> Education High School DiplomaAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $25.65This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 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: 05/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Health Concierge

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThis position will be on the Aetna Voluntary Underwriting team and is responsible for new business and renewal underwriting for Accident, Hospital Indemnity Protection, and Critical Illness products. The Senior Manager will administer strategy for Underwriting to support the organization’s financial and strategic goals, ensuring underwriting decisions are consistent, effective, and compliant.Key Responsibilities:<ul> <li> Strategic Planning &amp; Administration:<ul> <li>Contribute to the planning and administration of company programs and initiatives that promote the Underwriting area’s agenda.</li> <li>Implement organizational policies, goals, and objectives based on best practices in the field.</li> </ul> </li> <li> Underwriting Methodology:<ul> <li>Develop methodology to underwrite voluntary benefits products within established requirements to ensure profitability and achieve a consistent loss ratio target.</li> <li>Align management of large new and renewal group quotations to underwrite profitable business for the region.</li> </ul> </li> <li> Analysis &amp; Reporting:<ul> <li>Deliver analysis and reporting on underwriting key performance indicators and recommend actions for improvement.</li> <li>Advise on competitor activity, third-party activity, and changes in law that may affect underwriting performance.</li> </ul> </li> <li> Product Development:<ul><li>Participate in the design of new voluntary benefits products, ensuring they meet market needs and profitability targets.</li></ul> </li> <li> Team Management:<ul> <li>Manage operational aspects of the team, including budget, performance, and compliance.</li> <li>Implement workforce and succession plans to meet business needs.</li> </ul> </li> </ul> Required Qualifications<ul> <li>7 to 10 years of experience in underwriting.</li> <li>3 to 5 years experience in underwriting voluntary benefits products, including Accident, Hospital Indemnity Protection, and Critical Illness.</li> <li>Proven track record of developing and implementing underwriting strategies that drive profitability and growth.</li> </ul> Preferred Qualifications<ul> <li>Demonstrated ability to develop and execute long-term strategic plans that align with organizational goals.</li> <li>Experience in driving innovation and implementing new initiatives to enhance underwriting processes and product offerings.</li> <li>Experience in collaborating with sales, marketing, and customer service teams to develop and promote customer-focused underwriting solutions.</li> <li>Strong interpersonal skills and the ability to build and maintain relationships with key stakeholders, including clients, brokers, and consultants.</li> <li>Experience in leveraging technology to streamline underwriting processes and improve efficiency.</li> </ul> Education<ul><li>A bachelor’s degree from an accredited institution is required. Preferred fields of study include business administration, finance, economics, mathematics, or a related discipline. An advanced degree (MBA, Master’s) is a plus.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 06/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Underwriting Tech Lead

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Job Summary<ul> <li>Develops Network database tools that enable network management to work more efficiently and focus efforts effectively.</li> <li>Advises on provider performance, network adequacy, geographical coverage, and makes necessary network modifications or expansions.</li> <li>Implements improvement initiatives to ensure that network databases meet all applicable regulatory and quality standards.</li> <li>Conducts market analysis, assesses competitive positioning, and recommends strategies to maintain a competitive edge.</li> <li>Consults with internal teams, including medical directors, operations managers, and network development professionals, to align provider network performance goals and objectives.</li> <li>Provides continuous recommendations to senior leadership to guide decision-making and ensure close alignment with the organization's strategic goals and objectives.</li> </ul> Required Qualifications<ul> <li>A minimum of 5 years of SQL and QuickBase (developing and building of dashboards), Python, SAS, Access, Excel, Salesforce, and/or other large data management tools.</li> <li>Adept at machine learning and AI</li> <li>Adept at managing large amounts of data</li> <li>Adept at project management</li> <li>Adept at problem solving and decision-making skills</li> <li>Adept at collaboration and teamwork</li> <li>Adept at Growth Mindset with Mentorship Capability</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> <li>Adept at business intelligence (data driven insights)</li> <li>Intrinsically Driven</li> <li>Proactive Initiator</li> </ul> Preferred Qualifications<ul> <li>Prior Relevant Work Experience with a health system or large payor.</li> <li>Adept at Google Cloud/Desktop</li> </ul> Education<ul><li>Bachelor's degree preferred or a combination of professional work experience and education.</li></ul>Pay RangeThe typical pay range for this role is:$67,900.00 - $199,144.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/17/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr. Network Management Manager - QuickBase

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryReporting to the Lead Director of Medicaid Revenue Integrity, the Senior Manager will work closely with various Revenue Integrity Lead Directors and subject matter experts across the Medicaid business to establish and champion market level revenue integrity excellence. This position is responsible for supporting all assigned market level risk adjustment activities and processes related to complete and accurate diagnosis capture through provider and member engagement. In support of the Revenue Integrity Medicaid Performance Management Office (PMO) this position will lead the work and deliverables of multiple complex projects, focusing on process improvement, production, and data analysis. This individual should have proven project management of multiple complex projects simultaneously and demonstrate understanding of root cause analysis. This position may act as a liaison with other key business areas, internally and externally. The Medicaid Revenue Integrity Senior Manager will play a critical role in extracting, analyzing, and interpreting healthcare and financial data from multiple sources to address business opportunities regarding population health management, health and economic outcomes, and other business needs. Required Qualifications<ul> <li>5+ years of data analytics experience in healthcare environment or equivalent work environment</li> <li>5+ years of Project Management experience managing multiple projects simultaneously and meeting deadlines.</li> <li>2+ years of leadership experience</li> <li>Strong analytical and problem-solving skills</li> <li>Proficiency in Microsoft suite and data visualization tools (i.e. Excel, PowerPoint, Tableau etc)</li> <li>Excellent communication, presentation/creating presentations, and writing skills.</li> <li>Highly organized with excellent attention to detail</li> </ul> Preferred Qualifications<ul> <li>Knowledge of Risk Adjustment, preferably Medicaid</li> <li>Detail-oriented with a disposition to probe into technical details for accuracy and completeness</li> <li>Design and code efficiently in SQL, SAS, or similar programming language</li> </ul> Education Bachelor's Degree or equivalent work experience Pay RangeThe typical pay range for this role is:$67,900.00 - $182,549.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 05/16/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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