CVS Health

Product Manager

• developing new and innovative programs and services from ideation to execution in collaboration with drug manufacturer partners
• supporting the development and execution of strategic and tactical solutions, enhancements, patient journey mapping, and segment analyses
• aligning internal stakeholders on progress and next steps
• focused on the flawless execution of new solutions

Senior Manager – Trade Product Development

Accounts Receivable

• Apply advanced analytical and statistical techniques to identify root causes of Third-Party payer issues
• Validate data accuracy and completeness using SQL and internal reporting tools
• Translate complex findings into clear, actionable recommendations for leadership
• Collaborate cross-functionally to prevent recurrence of payer issues
• Maintain regular and predictable attendance and perform additional duties within role scope

Insurance AR Resolution Analyst, Revenue Cycle

Manager

• negotiate and execute high-level review and analysis, manage dispute resolution and settlement negotiations of contracts with single and group Behavioral Health providers within a defined market
• manage contract performance and support the development and implementation of strategic, traditional contracts and value-based contract relationships
• recruit Behavioral Health providers as needed to ensure attainment of network expansion and adequacy targets for all lines of business (Medicare, commercial etc.)
• collaborate cross-functionally to contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities
• provides Behavioral Health network development, maintenance, and refinement activities and strategies in support of cross-market network management unit

Contract Negotiation Manager – Behavioral Health

Associate

• Support the coordination of medical and social services for members
• Review, prioritize, and triage incoming Care Team tasks
• Screen members using established guidelines to identify care needs
• Initiate referrals to Case Management and other specialty programs
• Conduct outreach to members, providers, and care team partners
• Utilize internal systems to document member information accurately
• Support the development and implementation of member care plans
• Coordinate healthcare services and assist in identifying care options
• Perform non-clinical research to support case development
• Communicate effectively with internal teams, providers, and members
• Provide administrative and operational support
• Maintain accurate documentation in compliance with company policies

Care Management Associate

• Execute the organization’s Total Rewards strategy
• Ensure consistent application of compensation and benefits programs across a multi-state workforce
• Lead the annual compensation cycle, including merit increases, bonus planning, and execution
• Oversee benefits administration in partnership with brokers and external vendors
• Ensure compliance with federal, state, and local regulations across compensation and benefits programs

Senior Manager, Total Rewards & Benefits

Analyst

• Administer and maintain HR systems, ensuring optimal performance, data integrity, and system availability.
• Configure system changes, including workflows, fields, and business rules, in alignment with organizational requirements.
• Manage system updates, releases, and enhancements in partnership with vendors and internal stakeholders.
• Troubleshoot system issues, coordinating resolution with IT and third-party providers as needed.
• Ensure accuracy, consistency, and security of employee data across HRIS, payroll, and related systems.
• Conduct regular audits of HR data to identify discrepancies and drive corrective actions.
• Establish and maintain data governance standards, documentation, and data management protocols.
• Develop and deliver standard and ad hoc HR reports to support operational and strategic needs.
• Partner with HR and business leaders to translate data into actionable recommendations.
• Serve as a cross-trained resource for payroll processes, supporting payroll execution as needed.

Senior Analyst, HRIS – Omnicare

• Help elevate patient care through industry-leading support in serving dual eligible populations
• Collaborate with members, providers, and community organizations to address health care and social determinant needs
• Utilize a collaborative process of assessment, planning, facilitation, and care coordination
• Act as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel
• Implement and coordinate all case management activities relating to catastrophic cases and chronically ill members/clients
• Communicate with members/clients and other stakeholders as appropriate
• Prepare all required documentation of case work activities as appropriate
• Consult with internal multidisciplinary team to help member/client maximize health outcomes
• Provide educational and prevention information for best medical outcomes
• Monitor member/client progress toward desired outcomes

Case Manager, Registered Nurse – Field

Customer Advocate

• Servicing your assigned book of business
• Acknowledge customer’s inquiry within 1 business day
• Create and maintain PDET cases as outlined in policy guidelines
• Acts as the single point of contact for client’s operational inquiries and escalated issues
• Resolutions to include but not limited to Claims, Enrollment, ID cards, COBRA, FSA, Network Ops, PBM, Customer Service, EDI Files and Finance
• Provides plan document interpretation and ensures the client’s questions are addressed
• Conduct client portal training
• Supports operational departments to enhance the member experience through improved workflows and process improvements
• Identify opportunities that support account owners in developing and delivering strategic plans

Client Advocate I

• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
• Interacts with members/clients telephonically or in person.
• May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate.
• Prepares all required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.

Case Manager, Registered Nurse

Pharmacist

• leverage strong organizational and interpersonal skills to lead and manage a team focused on Specialty Generics optimization
• oversee Pharmacy Service Representatives (PSRs), Benefits Verification (BV) representatives, Work-in-Progress (WIP) representatives, and technicians to ensure efficient and compliant operations
• participate in the hiring process
• provide ongoing guidance, coaching, and direction to staff
• manage team schedules
• ensure adherence to standard operating procedures (SOPs)
• responsible for staff training and development
• problem-solving and follow-up
• performance monitoring and evaluation

Supervisor, Specialty Pharmacy Services

Medical Director

• Support Medical Management staff ensuring timely and consistent responses to members and providers.
• Lead all aspects of utilization review/quality assurance, directing case management.
• Provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities.
• 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.
• Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise.

Medical Director – Ortho/Total Joint

• Lead enterprise Release Management coordination across teams, ensuring efficient, predictable, and low-risk delivery
• Establish and govern ITIL-aligned release processes adaptable to Agile, Waterfall, and hybrid delivery models
• Oversee release readiness, risk and dependency management, and Go/No-Go decision-making
• Manage release schedules, ServiceNow change records, and stakeholder communication across functions
• Drive continuous improvement through automation, analytics, and adoption of AI-enabled release capabilities

Manager, Enterprise Release Management

Consultant

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
• Communicates with providers and other parties to facilitate care/treatment
• Identifies members for referral opportunities to integrate with other products, services and/or programs
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Utilization Management Nurse Consultant

• Support the pharmacy team in delivering operational and service excellence
• Ensure pharmacy operations run smoothly
• Fill patients’ prescriptions promptly, safely, and accurately
• Deliver caring service that exceeds patient expectations
• Complete basic inventory activities as directed

Pharmacy Technician

AI Engineer

• lead the product strategy, roadmap, and execution for a multi-agent AI decision intelligence platform
• serve as the bridge between business stakeholders, data science, engineering, and operations teams to deliver scalable AI-powered solutions
• define platform capabilities, prioritize investments, and drive the development of agentic AI workflows, predictive analytics solutions, and decision intelligence products
• translate complex business challenges into product requirements, manage cross-functional delivery teams, and ensure the platform delivers measurable value