CVS Health

Operations

• Lead the Operations Innovation team, providing direction, coaching, and development to team members.
• Partner with Strategy, Product, and Technology Enablement to identify technology solutions that advance MWB’s business objectives.
• Represent Operations throughout the project lifecycle, including: Building out intake and initiative evaluation process Assessing initiative business value and prioritization against other roadmap items Defining initiative ROI potential and business case development Gathering and documenting business requirements Making key workflow and process decisions Defining measurement approach and KPIs Defining and validating test cases Supporting defect resolution and solution optimization.
• Collaborate with the Change Management and Training teams to ensure operational readiness, effective go-live, and successful adoption of new technology.
• Drive process improvements and standardization to enhance efficiency, clarity, and solution quality.
• Serve as a key liaison between business and technical teams, ensuring alignment and clear communication.
• Monitor project progress, manage risks, and resolve issues to ensure successful delivery.
• Foster a culture of continuous improvement and innovation within the team.

Senior Mental Well-being Operations Innovation Manager

Data Engineer

• Design and build ETL/ELT data pipelines to ingest, process, and transform datasets from multiple sources
• Implement best practices for performance tuning, partitioning, and clustering to optimize data queries
• Follow data quality standards, data governance frameworks, and security policies for data storage and access
• Develop and optimize data models and schemas to support analytics, reporting, and machine learning requirements
• Collaborate with data scientists and analysts to design data solutions that integrate with BI tools and machine learning models
• Create comprehensive documentation for data pipelines, workflows, and processes

Analytic Data Engineer

Full-stack Engineer

• As a leader of a team of software development engineers, provide guidance and mentorship while establishing performance objectives that align with organizational goals
• Develop comprehensive strategies for software development projects, which include defining project requirements, assisting with design and solutions, while establishing timelines, and setting deliverables to ensure efficient execution
• Manage a team of software developers responsible for applications that plan sponsor domain supporting; benefit, case installation, data for plan sponsors
• Responsible for oversight of Plan Sponsor Managed Services production support team (supports approx.. 100 applications, staff of approx. 50 resources, a combination of onshore and offshore)
• Oversee risk assessment processes, resolve production issues, evaluate resource availability, and implement timely solutions to minimize operational disruptions
• Ensure adherence to industry best practices, quality standards, security standards, and current trends within the department and organization
• Collaborate effectively with cross-functional teams, including product managers and business stakeholders, to align priorities, address conflicts, and maintain strong working relationships to help deliver enhancements and new products to meet business objects and company goals

Senior Manager, Software Development Engineer

Actuary

• Overseeing the development, validation, and delivery of key medical cost assumptions used in annual pricing and bid development for Individual Medicare Advantage
• Ensuring all assumption models are completed accurately and delivered on time to the actuarial pricing team
• Collaborating closely with cross‑functional partners to confirm data integrity, review adjustments, and validate projection reasonability
• Ensuring all medical cost assumptions are CMS compliant and account for regulatory changes
• Managing and coordinating work across a team of supporting actuaries, ensuring alignment, quality, and timely execution
• Regularly presenting results, insights, and recommendations to actuarial and business leadership

Senior Actuary – Medicare Advantage

Medical Director

• Leading the IL Transitional Nursing team
• Providing programmatic support to national leadership and transitional staff
• Ensuring high-quality, patient-centered transitions from inpatient to outpatient settings
• Aiming to reduce readmissions and enhance satisfaction
• Overseeing daily operations and maintaining regional/facility assignment
• Balancing staff caseloads and monitoring team/individual performance
• Coaching staff as needed and providing coverage and support
• Assisting in the hiring and training of Transitional Care staff
• Executing effective collaboration between multi-disciplinary teams
• Monitoring compliance with CMS, state-specific and NCQA criteria
• Participating in daily inpatient and post-acute rounding calls

Medical Director – Population Health

Manager

• Develop, implement, and maintain scalable web applications and dashboards using Dash Enterprise or React frameworks.
• Collaborate with data science and business teams to design user-friendly interfaces that effectively communicate data insights.
• Ensure applications are secure, optimized, and meet usability standards.
• Troubleshoot, debug, and resolve technical issues in existing applications.
• Contribute to the design and implementation of front-end and back-end application components.
• Document processes, workflows, and technical designs to support project development and knowledge sharing.
• Stay up-to-date with the latest technologies and trends in web application development and visualization.
• Mentor and coach a small team of application developers to drive industry standard development practices and personal development.

Manager, Dashboard Development

Program Manager

• Support the Michigan Highly Integrated Dual Eligible (HIDE) and New York Fully Integrated Dual Eligible (FIDE) markets
• Oversee the strategy, development, implementation, and evaluation of population health initiatives aimed to reduce disparities and inequities
• Oversee the implementation, and evaluation of health equity efforts in the context of contract requirements, NCQA Health Equity Accreditation standards, and national and enterprise strategies
• Ensure the collection and meaningful use of race, ethnicity, language, disability, and geographic data to identify and analyze disparities for the development and implementation of plans to improve health outcomes
• Track the completion and evaluate the impact of staff and provider health equity training
• Inform decision-making regarding best payer practices related to disparity reductions
• Ensure that efforts addressed at improving health equity, reducing disparities, and improving cultural competence are designed collaboratively

Health Equity Program Manager

Data Analyst

• Analyze and interpret complex healthcare and financial data to inform business decisions
• Prepare and manage the annual budget for national programs
• Collaborate with cross-functional teams to champion revenue integrity excellence
• Support the development and implementation of new approaches to Medicaid Risk Adjustment

Senior Data Analyst – Medicaid Risk Adjustment

• Architect end-to-end solutions spanning frontend, backend, APIs, cloud, and data layers.
• Lead the design and implementation of reusable components, UI libraries, GraphQL APIs, and microservices.
• Partner with UX and product leads to translate user journeys into scalable, secure digital experiences.
• Establish full-stack engineering standards, design patterns, and best practices.
• Write high-quality, production-ready code across both frontend and backend stacks.
• Drive complex debugging, performance tuning, and reliability improvements.
• Implement automated testing across UI, API, and service layers (unit, integration, E2E).
• Build and evolve REST + GraphQL APIs, microservices (Java, Go, Node, Python), and orchestration layers.
• Lead technical execution for major features, re-architecting efforts, or platform modernization initiatives.
• Mentor senior and mid-level engineers on full-stack development, architecture, and clean coding.

Staff Software Engineer – Lead

Director

• Develop and own the roadmap for Business Intelligence and Performance to impact organizational objectives
• Align data initiatives with the company’s broader goals of value-based care and clinical efficiency
• Design, build, and maintain a standardized suite of enterprise-wide dashboards and performance metrics
• Ensure "one version of the truth" across all reporting layers
• In collaboration with business and tech leaders, ensure the integrity, security, and accessibility of data
• Establish rigorous protocols for metric definitions to prevent ambiguity in performance tracking
• Act the nexus between both corporate and field teams to ensure leaders understand business performance and recommendations for improvement
• Identify trends, bottlenecks, and opportunities within center level performance to positively impact financial performance

Executive Director, Business Intelligence and Performance

• Support the functions of the Fully and Highly Integrated Duals Eligible (FIDE/HIDE) quality program
• Handle regulatory deliverables, HEDIS activities and reporting
• Facilitate daily quality improvement (QI) functions
• Coordinate and monitor quality improvement and organizational projects from inception to closure
• Manage the annual quality program trilogy documents (program description, workplan, program evaluation)
• Ensure all quality policies are updated annually and in compliance with state contract
• Collaborate with stakeholders to implement innovative programs and initiatives
• Analyze data, develop reports and present to plan committees
• Manage data review process to ensure accuracy and integrity of data reports
• Implement interventions to increase HEDIS, CAHPS, and quality improvement projects
• Adhere to NCQA standards and maintain NCQA accreditation
• Support corporate compliance and external surveys
• Participate in project life cycle including requirements gathering and project execution
• Coordinate all data pulls and ongoing data management

Senior Manager, Health Care Quality

• Conducting comprehensive assessments to evaluate members’ needs
• Addressing SDoH challenges by connecting members with appropriate resources and support services
• Providing education and guidance to members and their families on managing chronic conditions
• Developing and implementing individualized care plans
• Monitoring member progress and advocating for necessary services
• Collaborating with interdisciplinary care team to ensure optimal health outcomes
• Accurate and timely documentation of assessments and interventions

Case Manager, Registered Nurse – NY License

• Help elevate patient care with 25-50% travel within Southwest Michigan
• Work standard business hours - 8:00AM-5:00PM, no night, weekend or holiday shifts
• Develop proactive plans of care for members to enhance outcomes and overall wellness
• Conduct evaluations of member's needs and benefits using clinical tools
• Collaborate with members, providers, and community organizations
• Use motivational interviewing skills for maximum member engagement
• Present cases at interdisciplinary case conferences

Case Manager, Registered Nurse – Field

• Leverages expertise to design and implement efficient and scalable solutions that meet business requirements and quality standards
• Contributes to solution design and architecture discussions, collaborating with architects and senior engineers
• Provides input on technical feasibility, performance optimization, and scalability considerations to ensure that the overall solution meets the desired objectives
• Participates in code reviews and ensures adherence to coding standards, best practices, and quality guidelines
• Communicates and coordinates with team members to ensure alignment, provide technical insights, and contribute to decision-making processes
• Contributes to the adoption of best practices, new technologies, and tools to enhance productivity, efficiency, and code quality
• Participates in knowledge sharing activities, such as code reviews, tech talks, and workshops, to foster a culture of learning and collaboration within the team
• Works with other developers and team members to implement complex features, enhance existing functionality, and ensure the delivery of high-quality code
• Provides guidance and mentorship to junior developers, helping them improve their technical skills and grow professionally

Senior Software Engineer – PSS

Consultant

• Perform concurrent clinical reviews of acute admissions using evidence-based criteria (e.g., InterQual, MCG).
• Collaborate with attending providers, case managers, and multidisciplinary teams to coordinate care, facilitate safe transitions, and advocate for optimal outcomes.
• Ensure medical necessity, appropriateness, and length-of-stay determinations align with contractual, regulatory, and accreditation standards (e.g., Medicaid, CMS, NCQA).
• Communicate clinical decisions to providers, member families, and internal stakeholders with empathy and clarity.
• Identify barriers to care, escalate complex cases, and participate in interdisciplinary rounds as needed.
• Support discharge planning and transition of care, engaging with families to address social determinants and unique member needs.
• Maintain accurate, timely documentation in UM systems, ensuring data integrity and compliance.
• Participate in quality improvement, policy review, and education related to utilization management.
• Serve as a clinical resource for internal and external partners.