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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 SummaryJob Description SummaryManages financial transactions, reconciles accounts, prepares financial reports, and ensures compliance with financial policies and regulations. Applies in-depth expertise in financial systems and processes to maintain accurate financial records, process payments, and contribute to the efficient operation of financial activities within the organization. A Brief Overview Manages financial transactions, reconciles accounts, prepares financial reports, and ensures compliance with financial policies and regulations. Applies in-depth expertise in financial systems and processes to maintain accurate financial records, process payments, and contribute to the efficient operation of financial activities within the organization. What you will do<ul> <li>Assists in the management of financial plans, budgets, and forecasts for the organization, including development and implementation.</li> <li>Confers financial reports and metrics to upper management, key stakeholders, and regulatory agencies in order to monitor financial operations.</li> <li>Directs teams to assess financial performance against budgeted goals, identify cost-saving opportunities, and implement strategies to control costs without compromising quality.</li> <li>Designs systems to ensure that the organization optimizes reimbursement, manages denials and appeals, and maintains compliance with healthcare regulations and insurance requirements</li> <li>Assesses metrics and output in order to ensure compliance with financial regulations.</li> <li>Helps establish and implement new initiatives including financial modeling, ROI analysis, and monitoring project budgets.</li> <li>Develops complex insights on specific contracts by assessing vendors, monitoring service level agreements, and optimizing financial arrangements with external parties.</li> </ul> Required Qualifications<ul> <li>5-7 years professional relevant work experience</li> <li>Adept at problem solving and decision making skills</li> <li>Adept at collaboration and teamwork</li> <li>Adept at growth mindset (agility and developing yourself and others) skills</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills</li> </ul> EducationBachelor's degree preferred/specialized training/relevant professional work experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$60,300.00 - $132,600.00This 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: 03/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Rebate Payment Manager

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position 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

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 SummaryFully remote position. Work from home anywhere in the U.S.A. Shift: Monday through Friday 11:30am to 8pm EST Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health.Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.<ul> <li>Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.</li> <li>Provides triage and crisis support.</li> <li>Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation.</li> <li>Coordinates with providers and other parties to facilitate optimal care/treatment.</li> <li>Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.</li> <li>Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.</li> </ul>Required Qualifications<ul> <li>Must have active current and unrestricted Independent clinical behavioral health license in the state of residence (LPC, LCSW, LMFT, LMHC, etc) </li> <li> 3+ years of behavioral health experience </li> <li>Must be able to talk on the telephone and type at the same time as this is a queue based position.</li> <li>Must be able to work Monday through Friday 11:30am to 8pm EST</li> </ul>​Preferred Qualifications<ul> <li>3+ years of direct clinical practice experience post master's degree, including hospital setting or alternative care setting such as ambulatory care or outpatient program</li> <li>Managed care and utilization review experience preferred.</li> <li>Crisis intervention skills preferred.</li> </ul>Education<ul><li>Master's degree required if social worker, LPC, LCSW, LMFT, LMHC, </li></ul>Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$60,522.00 - $129,615.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization management Clinician 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 SummaryAs a Manager, Network Disruption you will be responsible for managing inbound network disruption requests from the CVS Health Sales and Proposals teams in response to Requests for Proposals (RFP) which are used to win new clients and retain existing clients. You will distribute and track requests, review reporting for accuracy, assist in the creation of new tools and processes used to run network disruption reports, and communicate with internal partners in Sales, Account Management, Network Development, and Retail Analysis. You will also work with large claims datasets, analyze differences between current and proposed networks, manage multiple requests/priorities, and produce/develop custom reports for multiple lines of business and specific clients regarding retail pharmacy network accessibility using SQL, SAS, Tableau, Microsoft Access, Microsoft Excel, and other related applications. Key Responsibilities:<ul> <li> Request Management: Manage, distribute, and track network disruption requests from Sales and Proposals teams ensuring timely and accurate responses.</li> <li> Cross-Team Collaboration: Act as a liaison between the Network Disruption team and other internal departments, including Sales, Account Management, Network Development, and Retail Analysis, to ensure seamless communication and collaboration.</li> <li> Data Management: Build queries, perform data imports and extracts, analyze data, compare networks, and create reports to support network disruption requests from internal customers.</li> <li> Innovation: Assist in the development of new tools and processes for network disruption reporting.</li> <li> Custom Reporting: Produce and develop custom reports for various lines of business and specific clients regarding retail pharmacy network accessibility.</li> </ul> Required Qualifications<ul> <li>5+ years of experience in data analysis, network analysis, or a similar role.</li> <li>5+ years experience utilizing SQL, Big Query, Tableau, Microsoft Access, Microsoft Excel, or other related applications.</li> </ul> Preferred Qualifications<ul> <li>Experience in the PBM, healthcare or pharmacy industry.</li> <li>Familiarity with Requests for Proposals (RFP) processes.</li> <li>Advanced proficiency in data analysis and reporting tools.</li> <li>Excellent communication and interpersonal skills.</li> <li>Proven ability to manage multiple priorities and meet deadlines.</li> <li>Experience in network development or retail analysis is a plus.</li> <li>Strong analytical skills with experience in handling large datasets.</li> </ul> Education<ul> <li>Bachelors degree or relevant work experience required.</li> <li>Bachelor's degree in Computer Science, Information Technology, Data Analytics, or related field preferred.</li> </ul>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: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Manager, Network Disruption

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. This Senior Manager, Regulatory Affairs position is a crucial contributor to the Medicare regulatory and operations agenda of the Government Services division and broader PBM business. This position reports directly to the Director of Medicare Regulatory Affairs. Duties and Responsibilities: *Abiity to provide comprehensive market insights for key areas of priority for CVS Health’s Medicare lines of business. * Support various business units and the strategic priorities of those business units as appropriate. *Ability to read, interpret, and clearly explain complicated documents, including complex legislation and regulations. *Develop error free materials for management and executive committees, and possess the ability to create effective and error-free client communications that explain CVS Caremark's responsibilities related to CMS guidance and provide clear interpretation of CMS guidance. * Represent CVS Caremark by interacting directly with CMS representatives and officers who are responsible for making Medicare Policy and the CMS officers responsible for overseeing Medicare Operations. * Be an effective influencer to support CVS Health’s various regulatory positions and work with CVS Health Government Affairs team in assisting to influence/shape Federal regulations. Required Qualifications: *7+ years of total work experience *4+ plus years of PBM or Health Plan experience. *RX claim experience * Experience in strategic planning and product management preferred * Ability to lead and influence others and to effect change across organizational boundaries, particularly with large employers, health plans (PBM clients), regulatory bodies, and trade associations Preferred Qualifications: * Proven skills in strategic thinking and analytical skills, with the ability to diagnose complex problems and recommend practical solutions Education: *Bachelor's degree or relevant work experience considered. *Advanced degree preferred. 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: 03/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Sr Mgr, Regulatory Affairs

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.Implements Value Based Care (VBC) National Primary Care network strategies, monitors provider performance metrics, leads dispute resolution processes, and collaborates with key stakeholders to drive network growth and ensure high-quality provider relationships. What you will do<ul> <li>Develops and implements internal and external strategies to effectively assess and advance the performance of healthcare providers within the company's network.</li> <li>Develops and maintains provider scorecards and performance reports to track and communicate performance metrics to internal stakeholders, executives, and network providers.</li> <li>Monitors and evaluates provider performance metrics, such as quality indicators, patient satisfaction scores, cost efficiency measures, and adherence to clinical guidelines.</li> <li>Communicates with providers to develop and implement initiatives aimed at enhancing quality of care, patient outcomes, and operational efficiency.</li> <li>Contributes to business objectives by collaborating with the network development team to identify providers that align with the company's strategic goals and objectives.</li> <li>Manages operational aspects of the team, and implements workforce and succession plans to successfully achieve business goals.</li> <li>Guides management for individual performance evaluations aimed to provide critical feedback for skills development and depth of work area experience.</li> <li>Develop JOC decks and lead presentations with external facing provider groups</li> </ul> Required Qualifications:<ul> <li>A minimum of 5 years related experience with provider engagement, relations, or account management.</li> <li>Working knowledge of Medicare contracts.</li> <li>An understanding of value based contracts, how they work, what is the value.</li> <li>Strong presentation skills, the ability to communicate effectively.</li> <li>Mastery of problem solving and decision making skills </li> <li>Strong MS Office skills.</li> </ul>Preferred Qualifications:<ul> <li>The ability to use data to tell a story.</li> <li>Mastery of growth mindset (agility and developing yourself and others) skills.</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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 03/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Provider Performance Sr. Manager, Primary Care

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryAetna is recruiting for a Senior Manager, National Value Based Care (VBC) Development who will support innovative and strategic provider relationships as part of the VBC Business Development team. You will work collaboratively across the Network organization to ensure speed to market and to support segment leaders with growing our value-based care portfolio.You will make an impact by:<ul> <li>Support efforts focused on growing and maintaining strategic relationships with national provider partners with a focus on executing enterprise-wide initiatives.</li> <li>Support contracting efforts including negotiating contract deal terms and support the development and implementation of value-based contract relationships, serving as SME in support of business strategies across multiple lines of business, including Medicare Advantage, Medicaid, ACA, and Commercial.</li> <li>Develops relationships with providers and executes on go-to-market strategies and tactics around VBC risk deals to ensure attainment of network expansion and adequacy targets.</li> <li>Collaborates cross-functionally with various stakeholders internally and/or externally to scope/define projects, documentation of contractual information, and review/analysis of reports as part of VBC risk arrangement activities.</li> <li>Partners with cross functional teams, business areas, business segments to ensure all workflow processes and interdependences are identified and addressed.</li> <li>Provides network development/expansion, provider relationships, and refinement activities in support of cross-market network management.</li> <li>Support design, development, management, and/or implementation of strategic network configurations and integration activities as related to value-based care risk deals.</li> </ul>Required Qualifications<ul> <li>8-10 years of experience in Payer and Provider Value based care.</li> <li>Experience in Value Based Care financial models and value-based care contracting/negotiations</li> <li>Experience in Risk-based arrangements and Value-Based care in government services (Medicare Advantage, Medicaid, ACA)</li> <li>Proven negotiation skills including extensive experience leading Medicare advantage percent of premium/delegation deals.</li> <li>Ability to manage multiple priorities, and leading multiple complex negotiations at a time.</li> <li>Adept at execution and delivery (planning, delivering, and supporting) skills.</li> <li>Experience working in a highly matrixed environment.</li> </ul>Preferred Qualifications<ul> <li>Healthcare Industry experience with either a payer or provider</li> <li>Strong communication, critical thinking, problem resolution and interpersonal skills.</li> <li>Internal Aetna system knowledge a plus</li> <li>Proven working knowledge of provider financial issues and competitor strategies, complex contracting options, value-based agreements, financial/contracting arrangements, and regulatory requirements.</li> </ul>Education<ul><li>Bachelor's degree or or a combination of education and professional work experience.</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. 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: 04/19/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Network Development and Contracting, Primary Care

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryAetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Cardiology) that can be remote based, work from home.This role can be remote based anywhere in the US.The Medical Director (Cardiology) will be a Subject Matter Expert (SME) with a background in Cardiology specialty, including post-graduate direct patient care experience specifically. This role expands Aetna's medical management programs to address member needs across the continuum of care. In this role you'll support the Medical Management staff ensuring timely and consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management. In this role you will provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities You'll act as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams In addition, you will be responsible for predetermination reviews ad reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Required Qualifications* 2 or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry.* Active and current state medical license without encumbrances* M.D. or D.O.,Board Certification in Cardiology specialty including post-graduate direct patient care experience specifically Preferred Qualifications * Previous healthcare insurance experience. Education * M.D. or D.O.,Board Certification in a Cardiology specialty.Pay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">Benefits | CVS Health</a>We anticipate the application window for this opening will close on: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Medical Director - (Cardiology)

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

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