CVS Health

Analyst

• Acts as the primary resource for assigned, providers or groups to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs
• Optimizes interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships
• Monitors service capabilities and collaborate cross-functionally to ensure that the needs of constituents are met and that escalated issues are resolved
• Supports or assists with operational activities such as database management, and contract coordination. Performs credentialing support activities as needed
• Educates providers as needed to ensure compliance with contract policies and parameters, plan design, compensation process, technology, policies, and procedures
• Meets with key providers periodically to ensure service levels are meeting expectations. Manages the development of agenda, validates materials, and facilitates external provider meetings
• May collaborate cross-functionally on the implementation of large provider systems
• Conduct standard provider recruitment, contracting, or re-contracting activities and assist with more complex contracting and discussions as needed by business segment
• May provide guidance and training to less experienced team members

Senior Network Relations Analyst

Program Manager

• Joining the plan sponsor's wellbeing team in designing, facilitating and evaluating effectiveness of wellbeing programs
• Establishing rapport with plan sponsors, engaging leaders in data driven decision making regarding support for their employees
• Supporting wellbeing champion network including different levels of employer leadership and employees from worksite
• Providing guidance and recommendations to support trainings
• Identifying the appropriate combination of wellbeing activities for delivery and coordination of wellbeing programs
• Evaluating and presenting health assessment data, organizational assessment, claim utilization data, employee survey data, biometric screenings data, wellness incentive program data, or other data as appropriate
• Utilizing preventive guidelines and general health and wellbeing strategies to achieve goals in the overall health of customers
• Educating and referring customers on available health resources and community resources as appropriate
• Performing research on relevant topics in health promotion and disease prevention
• Creating and delivering health and wellness education workshops in person and via virtual meetings
• Leading presentations in person and using virtual meeting platforms to promote health education and wellbeing initiatives
• Building trusting relationships and rapport with customers, internal partners and external vendors
• Traveling to multiple plan sponsor locations for onsite events and presentations

Wellness Program Manager

• Supports the Practice Transformation team by helping to implement provider performance and quality management strategies
• Facilitates provider and member outreach to ensure member receipt of important clinical services
• Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements
• Makes outbound calls to members and/or providers to assist members in obtaining services
• Identifies when to refer member to Social Worker or Case Manager
• Develops and distributes educational information to members and providers
• Assists in the development and standardization of outreach documentation
• Documents member participation in outreach activities in accordance with abstraction and audit standards
• Conducts HEDIS provider chart request calls and mailings
• May develop and maintain member incentive programs to support HEDIS initiatives
• May identify opportunities to partner with community organizations on special events and presentations.

Health Care Analyst

Project Manager

• Develop an understanding of financial and operational data and processes across several areas of Pharmacy Benefit Management (PBM) Finance.
• Deliver critical data and insights to various teams.
• Translate complex business needs into actionable insights and project requirements.
• Collaborate with stakeholders to gather and understand business needs.
• Conduct thorough analysis of business processes to identify areas for improvement and optimization.
• Create detailed documentation of business requirements, functional specifications, process/data flows, and user stories.
• Partner with IT, BI development, and Automation/ Analytics team members to define requirements and ensure a seamless integration of processes with business workflows.
• Coordinate people and processes to ensure that projects are delivered on time and produce desired results.
• Develop the Business Requirement Document including scope and objectives, and a detailed project plan.
• Lead stakeholders and internal resources through project milestones until successful product delivery.

Senior Business & Project Analyst

Technical Product Manager

• Take ownership of key product roadmap items by defining strategies or features, conducting feasibility studies and business cases, outlining next steps, executing plans, and ensuring that they are delivering value to our clients and the enterprise
• Ensure milestones are met through effective project management and coordination across workstreams, identifying and communicating dependencies and risks
• Monitor program performance rigorously, proactively resolving issues to ensure flawless execution and continuous improvement
• Complete analyses and use data to inform decisions; present recommendations to leaders in efforts to develop products and solutions which will have a profound impact on the strategic direction of the company
• Create and manage documentation on product operations, outcomes, and financials
• Partner with stakeholders and multiple teams across the enterprise to ensure stakeholders satisfaction, operational effectiveness and program financial goals are achieved
• Develop presentations and briefings for internal and external stakeholders
• Become a subject matter expert for Rebate forecast engine and formulary tuner

Data Scientist

• Leads team to develop insights from data in order to investigate complex business problems through a range of data preparation, modeling, analysis and/or visualization techniques, including predictive analysis, business intelligence, pattern recognition, operational effectiveness and/or economic forecasting.
• Directs activities of data scientists, providing guidance, mentorship, and performance management to drive excellence in data science projects and deliverables.
• Defines data science strategies, methodologies, and best practices to solve complex healthcare challenges and drive innovation.
• Counsels the team in data exploration, analysis, and modeling techniques to derive actionable insights and inform healthcare decision-making processes.
• Directs activities of data science projects, including resource allocation, budget management, and timeline adherence, ensuring successful project execution.
• Analyzes organization to strategize and identify opportunities to leverage advanced analytics, machine learning, and artificial intelligence in healthcare applications.
• Advises senior leadership and stakeholders on data-driven strategies and solutions, providing insights and recommendations based on data analysis.
• Collaborates with multiple departments, including clinicians, researchers, and Information Technology (IT) professionals, to define project objectives, scope, and deliverables.
• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.
• Delivers a culture of learning and growth within the data science team, fostering collaboration, knowledge sharing, and professional development opportunities.

Senior Manager – Data Science

Pricing Analyst

• Review provider dispute resolutions according to organizational guidelines.
• Research and respond to provider participation and pricing inquiries, specifically related to network contracts and agreements.
• Research identified issues; submit claim adjustment requests and determine the root cause of disputes.
• Serve as subject matter expertise in evaluating and responding to provider participation and pricing inquiries.
• Analyze post-paid healthcare claims as it relates to pricing needs.
• Apply in-depth research to determine accuracy of PPO(s) use and pricing discounts applied.
• Communicate externally and with internal departments as it relates to various cases under review.
• Coordinate with other departments as necessary to facilitate resolution of claim related participation and pricing issues.
• Reading and interpreting appeals, standard reference materials, etc.
• Perform other duties as assigned.

Dispute Repricing Specialist

Consultant

• Utilize a collaborative process of assessment, planning, implementation and evaluation to engage, educate, and promote member's decisions related to health
• Conduct comprehensive evaluation of members' needs and benefit plan eligibility for programs/services
• Consult with supervisors, Medical Directors and/or others to overcome barriers to meeting goals
• Provide coaching, information and support to empower member's ongoing medical and lifestyle choices
• Develop and monitor established plans of care in collaboration with the member and/or attending physician

Registered Nurse – Health Coach Consultant

Manager

• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
• Responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.

Case Manager Registered Nurse – Field

DevOps Engineer

• Designs, develops, and implements digital solutions and systems
• Applies advanced technical expertise to architect and code software applications
• Conducts system testing and debugging
• Collaborates with cross-functional teams
• Contributes to overall technical direction and innovation of digital engineering projects
• Leverages expertise to design and implement efficient and scalable solutions
• Participates in solution design and architecture discussions
• Provides input on technical feasibility, performance optimization, and scalability considerations
• Participates in code reviews and ensures adherence to coding standards, best practices, and quality guidelines
• Communicates and coordinates with team members
• Contributes to the adoption of best practices, new technologies, and tools
• Participates in knowledge sharing activities
• Works with other developers to implement complex features and enhance existing functionality
• Provides guidance and mentorship to junior developers

Staff DevOps Engineer – Tech Lead

• Assessing, planning, implementing, and coordinating all case management activities with members
• Evaluating the medical needs of the member to facilitate the member’s overall wellness

Case Manager, RN

Recruitment

• Administers the talent acquisition strategy for the dental program and assumes the responsibility for sourcing, screening, and selecting dental professionals for various positions.
• Applies in-depth knowledge of recruitment methods to establish timelines and metrics for tracking and measuring recruitment outcomes.
• Communicates with dentists, dental hygienists, dental assistants, and administrative staff to identify target candidate profiles and determine the most effective sourcing methods.
• Conducts routine research to understand the competitive landscape and salary ranges within dental practices in order to attract and retain top talent.
• Configures the applicant tracking system (ATS) to extract candidate information from applications based on specific criteria.
• Designs the employer branding strategy and creates engaging recruitment marketing materials for social media platforms.
• Develops summaries and generates reports that illustrate the effectiveness of recruitment plans for senior management.
• Examines employment opportunity (EEO) regulations and professional licensing requirements to ensure that the recruitment process is conducted ethically and legally.
• Identifies opportunities for collaborating with recruitment consultants in order to attract and hire top-quality dental professionals.

Senior Analyst – Dental Recruiter

Compliance

• Oversee All Payer Claims Database (APCD) states
• Ensure organizational adherence to all regulatory requirements
• Manage high risk areas
• Handle vendor and regulator requests regarding laws, bulletins, and other requests
• Deliver all file types and responses to inquiries
• Set timelines for new APCDs
• Write requirements for all systems and affiliates
• Mentor and train within the team and across organizational lines
• Create reports for management
• Identify issues and communicate findings and potential resolutions with management and IT teams
• Run, review, and set up projects end to end including timelines and extensions
• Translate regulations into business requirements
• Use automated and non-automated tools for project management
• Research and investigate issues identified internally and by customers
• Identify possible system issues and assist with corrections
• Write complex business requirements based on findings
• Utilize knowledge of data sources, systems, and products to influence process changes
• Build strong teams within the APCD team and across other teams

Compliance Manager

Operations

• Lead the development and support of store and field processes, systems, and applications in unique markets and store formats
• Manage cross-functional projects and programs, ensuring effective coordination
• Conduct root cause analysis to identify system issues and provide solutions for inventory challenges
• Leverage data-driven insights to inform strategic decisions and optimize business outcomes
• Define requirements for system enhancements, oversee testing, and coordinate deployments
• Develop and maintain financial and operational reporting for initiatives
• Guide and develop a high-performing team, providing coaching and feedback
• Oversee daily inventory support activities, including second-level Help Desk support and Inventory Operations Mailbox
• Create and maintain standard operating procedures and training materials
• Ensure efficient execution of inventory management rollouts and initiatives
• Maintain data sources, create reporting tools, and execute ad hoc reporting

Senior Inventory Operations Manager

• Management Lead others and work effectively with store crews
• Supervise, assign and direct activities of the store’s crew
• Effectively communicate information to store crew and supervisors in an open and timely manner
• Support Store Manager with actions plans for operational and service improvement
• Customer Service Assist customers with their questions, problems and complaints
• Promote CVS customer service culture (greet, offer help, and thank)