CVS Health

Manager

• Responsible for the coordination and implementation of repairs and maintenance within a specified geographic region (typically 600 to 800 locations).
• Partner with CVS Health Operations Management and vendors to ensure highly complex repair and maintenance issues (i.e. disaster recovery efforts) are completed on time, at the most economical cost.
• Perform comprehensive administrative tasks involving the approval or denial of proposals from repair and maintenance contractors.
• Responsible for sourcing and management of contractors to deliver the most economical and effective repair and maintenance services.
• Perform comprehensive financial review and management to ensure capital and operating budgets are achieved.
• Serve as CVS Health project manager for projects within assigned facility(s), and represent CVS Health in legal matters associated with repair and maintenance services.
• Conduct regular inspections and audits of facilities to assess conditions and repairs needed.
• Perform administrative tasks relating to approval or denial of proposals from vendors for repair and maintenance actions.

Regional Facilities Manager

Consultant

• Serve as a pivotal resource for the organization’s intricate and high-value client portfolios
• Autonomous management and resolution of multifaceted eligibility issues
• Engage cross-functionally with internal departments, external clients, and broker partners to deliver expert guidance and solutions
• Function as the principal escalation point prior to Manager or Director intervention
• Ongoing development and mentorship of junior staff
• Design and implement comprehensive training programs
• Orchestrate and align daily operational objectives
• Identify and execute process optimization strategies
• Leverage subject matter expertise to drive continuous improvement and operational excellence across the eligibility function

Eligibility Consultant

Operations

• Oversee and ensure the accuracy and compliance of eligibility protocols and standards for department processes
• Analyze data and conduct verification checks to ensure the accuracy and completeness of all documentation
• Create tools, gather data, and conduct analysis in the development of processes to define and measure across the department and multifunctional areas
• Lead and assist with new products and services impacting the department
• Identify and implement enhancements to processes and systems resulting in operational efficiencies and improvements
• Ensure full compliance with relevant regulations, contractual obligations, and internal policies when assessing eligibility data and department processes
• Evaluate complex or high visibility cases, identify risk and recommend appropriate measures to manage risk
• Collaborate with other departments to address inquiries, clarify eligibility requirements, enhance processes, and resolve concerns
• Solve complex problems, take a new perspective on existing solutions, research and respond to eligibility and other enrollment related issues
• Identify opportunities to streamline and enhance the eligibility determination process, making key recommendations to management for review
• Generate reports and analyze eligibility data to identify trends, patterns, and insights
• Develop training materials and conduct training sessions for employees or stakeholders involved in or connected with the eligibility process
• Manage assigned projects and ensure project plans and work tasks are in alignment with overall department and organizational goals; manage multiple tasks and shifting priorities
• Operate independently and take initiative, anticipate and prevent problems and roadblocks before they occur, provide accurate and timely results

Senior Analyst, Eligibility Operations

Account Executive

• Serve as consultative lead on specialty product solutions to improve member outcomes and effectively manage specialty trends.
• Grow business in specialty pharmacy and medical benefit solutions.
• Responsible for PBM Health Plan clients for all lines of business.
• Support renewal, retention, and product up-sell for existing clients.
• Manage specialty client satisfaction, strategy, contracts (pharmacy, medical, product, etc.) and contract terms (such as performance guarantees), and service delivery.
• Lead the account as the specialty quarterback by partnering with internal teams.
• Own strategic specialty client relationships with C-suite and day-to-day points of contact.

Specialty Strategic Account Executive

Account Manager

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Account Manager – Analyst

• Develop and execute communication strategies for new enhancements, including field and store communications, job aids, FAQs, and leadership materials
• Gather and implement colleague and patient feedback to inform IT enhancements, reporting, and workflow prioritization
• Provide quarterly workload submissions for upcoming field and store communications and training
• Partner with key stakeholders to align strategies and ensure successful deployment of initiatives
• Monitor and report on program metrics, providing bi-weekly leadership updates
• Investigate and respond to executive complaints, Board of Pharmacy inquiries, and Attorney General investigations
• Monitor communication channels, identify emerging themes, and ensure knowledge resources remain current
• Maintain and update product feature documentation and related program materials on a regular cadence
• Partner on initiatives that enhance program alignment and improve calculation or reporting processes
• Provide updated content for workforce planning and participate in periodic operational reviews
• Advance a scalable, actionable, and customizable data insights product leveraging inbound patient communication channels (MTP, Voicemail, IVR, 2-way SMS) to provide Voice of the Customer data
• Lead the presentation of insights and potential solutions to stakeholders across Operations, Product Development, and Trade to influence prioritization of downstream work
• Collaborate with cross-functional teams to identify and implement improvements that enhance patient and colleague experiences
• Drive change agility and foster collaboration across departments to achieve organizational goals
• Promote a culture of inclusion and well-being, ensuring alignment with CVS values
• Encourage continuous development through enterprise tools such as DevelopU and LearningHUB
• Act on feedback from development sessions and prioritize growth beyond current role.

Inbound Communications and Channel Operations Manager

• Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
• Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
• 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.
• Interacts with members/clients telephonically or in person.
• 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.

Case Manager, Registered Nurse – Field IL

• 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

UM Nurse Consultant

Business Operations

• Lead the documentation of business process for operational workflows critical to the success of Employer Portal administration.
• Include operational support team process, business partner process that needs to change/modify as a result of features introduced in the portal, and registration workflows through AccessHub.
• Develop and document migration plans for applications and tools that will be sunset once the features in the Employer Portal are available for clients to utilize.
• Work closely with the Business General Manager and Program Manager of the Employer Portal to ensure all business readiness needs are identified, supported and implemented.

Business Process Lead

Program Manager

• Responsible for providing program/project oversight, day-to-day management, leadership, direction, and administration across the full project lifecycle.
• Managing team/stakeholder expectations and engagement through clear communication of roles and responsibilities and regular status updates.
• Oversee the work of other Project Managers and provide timely, written feedback on project and performance reviews.
• Lead large, cross-organizational programs and projects with high visibility and critical timelines.
• Drive successful delivery of all programs and projects on time, within scope, within budget, and in full compliance of CVS Health requirements.
• Resolve complex business issues / risks and understand when to escalate to ensure resolution.
• Define and document project scope, ensuring all relevant subject matter experts are engaged to produce competent and comprehensive requirements.
• Work with business users and owners to understand their needs and translate into final project deliverables.
• Produce a detailed project plan and monitor and control activities to remain on plan.
• Produce regular and thorough stakeholder communications.
• Manage resource availability, allocation, and project financials where applicable.
• Manage changes to scope, schedule, and cost.
• Ensure required project artifacts are completed and stored in the project repository.
• Help on board and mentor new PMs.
• Identify and implement process improvements related to the project management standards for the team.

Senior Manager, Program Management

• Schedule is Mon-Fri 8:00 or 8:30 -5:00 PM with one 7:00 PM rotational shift
• 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 – Medicare Acute Care

• Leads process improvement (PI) opportunities with relevant deliverables: process maps, baseline performance metrics, root cause analysis, recommended actions, and control plans
• Participate in strategic and lead targeted assessments and support relevant deliverables: framing, data collection, analysis/interpretation and recommendations/report-out
• Run FOX topics with relevant deliverables: problem statement, story/narrative, root cause analysis (5 why’s), corrective actions (as applicable), supporting questions and facilitate the live call
• Utilize FOX, DMAIC, LEAN, 8D and other relevant methodologies in delivery of results
• Ability to act as an improvement/change agent, supporting efforts from identification through delivery and validation of results
• Develop project charters in conjunction with Subject Matter Experts (SME's) and stakeholders, edit and gain approval on updates to approved charters as required
• Document current and target state processes using Supplier, Input, Process, Output, Customer (SIPOC), flow charts and value-stream mapping (VSM) tools
• Use Pareto diagrams, 5 Why's, time-series, process control charts and inferential statistics to support opportunity definition, root cause analysis and validate result(s)
• Lead working teams through FOX, Improvement and Assessment projects leveraging project management basics to create the plan, define team member role & responsibility, develop a working team package, and publish bi-weekly leadership updates
• Use a RAID (risks, issues, actions, decisions) to effectively identify, track, resolve and escalate items (as required) to keep project(s) moving forward in a timely fashion

Process Improvement Specialist – 6 Sigma Black Belt

Analyst

• Provides comprehensive support and service to behavioral health clinical teams in support of member engagement
• Provides outreach to members to educate them about available specialty programs and to solicit their participation
• Assists members locate services
• Facilitates follow-up calls
• Collects information on patient progress and adherence to treatment plan
• Provides information to members regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna policies and procedures
• Works closely with the clinician to ensure healthy outcomes for the member
• Miscellaneous administrative duties such as Provider/community resource searches
• Handling Transition of Care requests
• Executing letters of agreement with non-par providers
• Obtaining discharge verifications and non-complex authorizations
• Monitor referral task lists in multiple systems
• Log and assign new case management cases to Case managers across the department
• Verify eligibility for case management by verifying member's insurance coverage
• Ensure applicable turnaround times are met
• Participates in designated team meetings with team members and clinical staff
• Adheres to compliance and Patient Management policies and regulatory requirements
• Maintains accurate and complete documentation of required information meeting risk management, regulatory, and accreditation requirements
• Participates in designated clinical quality management initiatives

Behavioral Health Care Planner, Analyst

Full-stack Engineer

• Collaborate with product managers, architects, and fellow engineers to design and implement services and features that improve patient experience and clinical workflows
• Proactively identify opportunities for improvement, drive solutions forward, and model best practices in software engineering
• Take ownership of complex technical challenges and deliver robust software
• Influence the direction of our next-generation platform

Senior Software Engineer

• Lead multiple engineering teams responsible for delivering the next generation of clinical and patient-facing platforms
• Guide teams of Software Engineers and related engineering functions—including QA, DevOps, and Architecture partners—to build scalable, reliable, and secure solutions
• Provide strategic and technical leadership, build high-performing teams, and ensure execution excellence across multiple initiatives
• Foster a culture of continuous learning, promoting self-motivated ownership, and empowering engineers to deliver high-impact outcomes
• Partner closely with Product, Architecture, Clinical Operations, and enterprise technology teams to translate business goals into actionable engineering plans