CVS Health

Director

• accountable for the strategic alignment, operational success and performance management of assigned provider relationships
• ensure that assigned value based contract arrangements are functioning successfully
• work to improve quality of care while reducing costs
• includes supervisory responsibilities for VBS Provider Performance team members
• provide dedicated leadership and oversight for Medicaid value-based care initiatives across the Florida and Louisiana markets
• development, execution, and oversight of Medicaid focused value-based contracting and provider performance strategies

Lead Director, Network Management – Value-Based Care

• establish and maintain productive value-based relationships with key network providers
• develop and manage the Keystone Value-based Network
• negotiate high value/risk contracts with complex arrangement structures
• manage complete value-based contracting cycle
• work with internal teams to develop a value-based strategic plan
• oversee contract performance with targeted provider groups
• evaluate and implement network strategic plans

Lead Director, Provider Performance Value-Based Care

Business Operations

• Identify root causes of complex business and process issues
• Analyze current processes and design improved future-state solutions
• Lead process improvement and reengineering initiatives (including DMAIC projects)
• Recommend solutions that improve efficiency, quality, and speed
• Partner with finance stakeholders to understand needs and deliver results
• Create clear documentation, dashboards, and performance metrics
• Communicate insights clearly to all levels, including senior leaders
• Manage multiple projects and shifting priorities in a matrixed environment
• Build strong relationships and influence without direct authority

Business Process Engineer – Finance Transformation

Manager

• Define and drive the quality engineering strategy for ACAS benefits testing, aligned with enterprise TCOE standards.
• Champion shift‑left quality practices, including early validation of requirements, benefit configurations, and adjudication logic.
• Establish engineering‑led approaches to defect prevention, testability, and quality gates.
• Lead the adoption and expansion of automation‑first testing for benefits and claims adjudication scenarios.
• Partner with automation architects and engineers to design scalable test frameworks, reusable assets, and data strategies.
• Define risk‑based testing models focused on high‑impact benefit configurations and claim scenarios.
• Guide teams in assessing claim exposure, financial risk, and member/client impact associated with defects.
• Analyze defect trends to identify systemic issues and inform upstream process or design improvements.
• Establish and monitor quality KPIs (defect leakage, automation coverage, test effectiveness, rework reduction).
• Drive continuous improvement initiatives to improve testing efficiency, consistency, and outcomes.
• Communicate quality risks, trends, and recommendations clearly to senior stakeholders.

Senior Manager – ACAS, Commercial Benefits Testing

Analyst

• responsible for development and implementation of member materials for Medicare Part D members
• managing, proofing, and revising materials while ensuring quality, accuracy, and timely delivery to production partners
• proofreading and editing both CMS required and custom documents
• collaborating with teammates & partners with other functional business areas to ensure all workflow processes are completed and remain on track
• collaboratively works with internal partners to obtain agreement from all impacted parties
• collaboratively drive process improvements and enhancements and implement new ideas that supports and improves the team
• independently identify and problem solve issues that negatively impact projects and documents

Senior Member Materials Analyst

Account Manager

• Serves as day-to-day contact for customers - supports customer-level questions and requests on enrollment, claims questions, escalated issues
• Identifies constituent-specific service issues, identifies solutions and may lead resolution
• Provides constituents with Aetna policy, plan design and benefit changes and network updates including analysis of impact
• Collaborates with account management team to achieve growth/renewal objectives; may assist in preparation and delivery of renewal packages
• May support plan administration activities
• Creates collaborative partnerships with sales to develop a comprehensive growth strategy for assigned book of business

Account Representative

Pharmacist

• Support the pharmacy team in delivering operational and service excellence
• Assist the pharmacy team to ensure that pharmacy operations run smoothly
• Deliver additional patient health care services, including immunizations
• Complete all necessary training and satisfy registration, licensing, and certification requirements

Pharmacy Technician

• Managing the execution of multi-channel communications
• Project Manage assigned programs from initiation through deployment
• Manage the creative and data delivery to vendors
• Communicating with internal partners, customers and vendors

Senior Analyst, Member Communication

• Conducting in-home assessments using comprehensive tools
• Creating and managing individualized care plans
• Coordinating services such as adult/pediatric daycare, personal care, and nursing facility placements
• Collaborating with members, families, providers, and interdisciplinary teams
• Ensuring cost-effective service delivery and accurate documentation
• Mentoring new hires once proficient
• Traveling 50–75% within assigned counties

Case Manager, Registered Nurse - Field

Chief of Staff

• Serve as strategic advisor to the EVP & President, Pharmacy Services
• Partner EC leadership to initiate, develop, and execute both long and short-term strategic plans.
• Ensure execution of management processes and follow up on action items.
• Provide an end-to-end overview of all PSS related processes and functions to ensure alignment across all areas of the Enterprise and proactively anticipate problems/challenges to address them.
• Manage critical PSS projects and create success in complex projects to achieve implementation.
• Serve as a conduit to connect strategy to senior leadership and key stakeholders to optimize enablement and delivery of outcomes.
• Proactively prepare senior leaders for engagements with key clients and strategic partners.
• Oversee the development and communication of strategic plans ensuring operational alignment to strategy for the business.
• Support and/or lead monthly staff meetings, leadership team meetings, town-halls, and other meetings as requested by coordinating with Executive Assistant to set the agenda, coordinate materials/speakers, ensure presentations are ready, lead sessions, and ensure follow-up on action items.
• Identify issues/gaps in processes or the organization, coordinate analysis and challenge self and others to develop and implement solutions.
• Drive change to improve performance results, organization effectiveness, and/or systems/quality/services (e.g., policies, processes, or systems).
• Ensure consistent, efficient, and cost-effective processes, procedures, and appropriate accountability.
• Effectively manage organization resources (e.g., staff, budget).

Vice President, Chief of Staff – Pharmacy Services

• Support the pharmacy team in delivering operational and service excellence
• Assist patients and customers to deliver an exceptional experience
• Ensure that pharmacy operations run smoothly
• Fill patients’ prescriptions promptly, safely, and accurately
• Complete basic inventory activities
• Provide caring service that exceeds patient expectations
• Follow all company SOPs at each workstation

Compliance

• Lead end-to-end audit readiness and execution for internal and external audits
• Establish and maintain centralized tracking of audit activity
• Drive development, tracking, and validation of corrective action plans
• Serve as a subject matter expert on Medicaid regulatory requirements
• Leverage data analysis to identify trends and emerging risks
• Build partnerships across Compliance, Credentialing, Network, and Operations

Senior Manager, Medicaid Compliance – Provider Data Services

Customer Support

• Communicates with customers over the phone or through other communication channels to address their medication-related concerns and ensure optimal medication therapy management.
• Verifies the accuracy and appropriateness of prescription orders received from customers, ensuring that the prescribed medications align with the patient's health conditions and potential drug interactions.
• Responds to patient inquiries about drug information, such as medication dosages, storage requirements, and potential drug interactions.
• Conducts research on insurance processes to assist patients with insurance-related inquiries and resolve issues with medication claims and reimbursement.
• Designs a comprehensive customer care system for the pharmacy network to facilitate record-keeping of patient profiles and medication histories.
• Develops a collaborative care network with physicians, nurses, and healthcare providers to ensure seamless patient care, ultimately leading to a more positive patient experience.
• Establishes customer care service protocols to emphasize the importance of exceptional customer service by addressing medication-related concerns.
• Helps establish and implement the pharmacy's medication safety plan to monitor for potential medication errors, adverse drug reactions, and contraindications.
• Integrates reminder systems, medication synchronization, and counseling into customer care practices to ensure quality customer service.

Pharmacist – Retail Customer Care

• Lead and support projects related to provider standardization, provider experience, operational effectiveness, and data quality initiatives
• Manage initiative lifecycles from intake through implementation, including requirements gathering, planning, execution, risk identification, stakeholder alignment, and sustainment activities
• Track initiative progress and communicate updates, risks, barriers, and recommendations to leadership and stakeholders
• Support execution of strategic initiatives and special projects as assigned
• Evaluate current workflows and operational processes to identify inefficiencies, manual work, bottlenecks, and improvement opportunities
• Support process mapping, root cause analysis, and development of future-state workflows where appropriate
• Recommend improvements that improve accuracy, reduce turnaround times, enhance quality, and support scalable operations
• Analyze operational trends, stakeholder feedback, and business needs to identify improvement opportunities and support recommendations
• Partner with internal business teams, operational areas, and leadership to define objectives, requirements, risks, and expected outcomes for initiatives
• Facilitate discussions, drive follow-ups, and maintain alignment across stakeholders throughout project execution
• Support change management activities associated with new processes, implementations, or operational changes
• Act as a liaison between operational teams, business partners, and supporting functions including reporting, technology, or implementation teams as needed
• Support monitoring of operational performance through existing dashboards, metrics, and reporting processes
• Help identify reporting gaps, business needs, and opportunities for improved visibility into operational performance
• Assist in development of presentations, status updates, and executive-level summaries

Senior Analyst, Provider Standardization – Strategic Initiatives

Business Analyst

• monitors and reports on adherence to role-based access controls
• performs regular internal audits to ensure data integrity and privacy
• engage in and respond to third-party audit requests
• exhibit a professional attitude, communication style, and presence
• conduct routine audits reviewing and assessing compliance with departmental policies and procedures on data migration, EPCS, system access
• provide requested reports and documentation as required and coordinating with IA SOX to respond to any findings
• configure compliance reports highlighting findings, recommendations and areas of concern
• administer investigations into potential compliance violations or breaches, gathers evidence, conducts interviews, and prepares reports on the findings
• monitor disaster recovery exercises tracking scheduling compliance and completion
• serve as a bridge between Epic technical teams and Internal Audit
• coordinate meetings to review findings and deficiencies with teams and assist in remediation plans
• draft, prepare and disseminate education on identified compliance violations with minimal manager supervision
• manage smaller projects with multiple teams and participates in multi-disciplined project teams
• maintain documentation for routine audits, compliance reports and Audit Board requests
• monitor clinical and technical team adherence to policies and procedures
• analyze internal controls, policies and procedures, identify weaknesses and recommend improvements
• collaborate with Epic Security group to ensure all Epic certifications are up to date for Epic analysts with EMR access
• monitor planning and testing of downtime and disaster recovery procedures
• leverage ServiceNow for incident management review and change control compliance

Lead Director, Network Management – Value-Based Care

Lead Director, Provider Performance Value-Based Care

Business Process Engineer – Finance Transformation

Senior Manager – ACAS, Commercial Benefits Testing

Senior Member Materials Analyst

Account Representative

Pharmacy Technician

Senior Analyst, Member Communication

Case Manager, Registered Nurse - Field

Vice President, Chief of Staff – Pharmacy Services

Pharmacy Technician

Senior Manager, Medicaid Compliance – Provider Data Services

Pharmacist – Retail Customer Care

Senior Analyst, Provider Standardization – Strategic Initiatives

Compliance & Environment Management Analyst