CVS Health

Pharmacist

• Processes prior authorization requests received by phone, fax, or electronically
• Completes prior authorization approvals and denials
• Follows prior authorization workflow, policies, and procedures
• Answers inquiry calls from providers and pharmacies
• Participates in training and continuing education

Pharmacy Technician – Prior Authorization

Architect

• connect business needs with technical execution
• engage closely with business stakeholders to clarify and refine requirements
• translate high-level concepts into actionable roadmaps and user stories
• ensure alignment across cross-functional teams
• develop high-level and detailed solution designs
• document current-state architectures
• propose scalable, secure improvements for future-state systems
• primarily work within Google Cloud Platform (GCP)
• support the integration and modernization of internal applications
• create and maintain architecture roadmaps
• estimate development efforts
• ensure solutions are strategically aligned with business goals

Lead Architect

Account Executive

• responsible for selling CVS/specialty pharmacy services to key targeted physicians, medical clinics, hospitals, and academic institutions
• support the Oncology, IVIG, Pulmonary Hypertension / IPF, Autoimmune, and be the primary contact for respective providers within the assigned territory
• work independently to formulate and execute effective marketing plans in the designated territory
• measure success through percent to sales goal metrics, internal and external client satisfaction and success of aligned Inside Sales Representative(s)

Territory Sales Executive – Pharmacy Services

Events

• Assists with establishing and implementing results-based programs for the Prevention & Wellness area
• Applies in-depth knowledge of the Prevention & Wellness field to offer feedback and innovation strategies
• Develops, implements, and assures ongoing coordination of prevention and wellness activities
• Evaluates, analyzes, reports on, and records outcomes of scheduled interventions

Senior Outreach Coordinator, Prevention & Wellness – Bilingual Spanish

Manager

• Negotiates, executes, conducts high level review and analysis of dispute resolution and/or settlement negotiations of contracts with national providers
• Recruit providers as needed to ensure attainment of network expansion goals
• Support health plan with expansion initiatives or other contracting activities as needed
• Initiates, coordinates and own the contracting activities to fulfillment
• Responsible for auditing, building, and loading contracts, agreements, amendments and/or fee schedules in contract management systems per Aetna ’ s established policies
• Conducts research, analysis and/or audits to identify issues and propose solutions
• Manages contract performance and supports the development and implementation of value-based contract relationships
• Collaborates cross-functionally to manage provider compensation and pricing development activities
• Provides Subject Matter Expert support for questions related to recruitment initiatives, contracting, provider issues/resolutions, related systems and information contained
• Provide guidance and share expertise to others on the team
• Understanding of Value Based contracting and negotiations
• Manage high level projects and recruitment initiatives with interdepartmental resources and/or cross functional stakeholders
• Supports or assists with operational activities that may include, but are not limited to, database management and contract coordination
• Organizing and transforming information into comprehensible structures
• Using data to predict trends in the customer base and the consumer population as a whole
• Performing statistical analysis of data
• Using tools and techniques to visualize data in easy-to-understand formats, such as diagrams and graphs
• Preparing reports and presenting these to leadership
• Engage with providers and quickly move the providers though contracting processes

Senior Network Provider Manager, National Medicaid Ancillary Contracting

Solutions Engineer

• Provide enterprise-level technical leadership across complex, business-critical platforms
• Own and evolve end-to-end solution architecture for highly complex, cross-domain initiatives encompassing application, integration, and data architecture.
• Lead modernization of distributed platforms spanning cloud-native and legacy environments.
• Define and enforce reference architectures for microservices, APIs, event-driven systems, and data platforms.
• Design integration architectures leveraging APIs, event streaming, and asynchronous messaging to decouple systems and enable resilience.
• Define and own data architecture strategies including domain-oriented data models, canonical data definitions, and system-of-record design.
• Design and guide implementation of agent-based and agent-orchestrated architectures to support complex workflows and decision-making.
• Champion AI-assisted software development practices including code generation, refactoring, test creation, impact analysis, and documentation automation.

Principal Architect, Solution Engineering, AI – Architecture

Content Writer

• drafts, reviews, and edits medical, dental and vision plan documents
• support plan document needs for new business by creating plan documents and summaries of benefits and coverage (SBC’s)

Senior Document Writer

• 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
• 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 conversation
• 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
• Travel can be up to 40% of the work week

Registered Nurse, Case Manager

QA Engineer

• Creates and executes the test design and execution strategy for the engineering department coordinating with business, product, development team.
• Develops comprehensive test cases, scripts, and scenarios based on engineering project requirements, ensuring strong coverage of both functional and non‑functional needs.
• Executes functional testing, regression testing and coordinates with business, product, development team to clarify on expected test outcome.
• Own defect creation, re-test after defect fix, close defects.
• Analyzes the complexities of project defects and works closely with quality assurance development teams to investigate and resolve issues.
• Applies in-depth knowledge of quality assurance principles to facilitate the creation of detailed test plans and schedules.
• Communicates with cross-functional engineering teams to reinforce transparency, effective communication, and alignment with quality expectations.
• Completes periodic reviews within the testing environment to ensure configurations match the internal environment.
• Conducts routine assessments in collaboration with the engineering team to measure and monitor performance and quality.
• Configures system applications for test automation efforts to improve coverage, efficiency, and reliability.
• Coordinates with IT infrastructure teams, database administrators, and system analysts to establish and maintain the testing environment.
• Designs complex process improvement initiatives that use quality assurance methodologies to enhance efficiency and effectiveness.
• Conduct User Acceptance Testing.

Quality Engineer – IBMi

Data Scientist

• lead the development of series of customized GenAI solutions
• focus on building scalable, production-grade systems using Python and modern frameworks
• emphasis on generative AI applications such as information retrieval, AI assisted web search, Retrieval-Augmented Generation (RAG)

Data Scientist – GenAI

Analyst

• Simplifying health care one person, one family and one community at a time
• Collaborate with teams to provide better health experience

Medical Claims Analyst

Business Analyst

• Conduct comprehensive evaluation of referred member’s needs/eligibility
• Recommend approach to case resolution and/or meeting needs
• Coordinate and implement assigned care plan activities and monitor care plan progress
• Consult with case managers, supervisors, Medical Directors and/or other health programs
• Identify and escalate quality of care issues through established channels
• Secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

Case Management Analyst

Operations

• Follows processes to assist with processing, insurance verification and authorization
• Analyzes insurance plans and policies
• Ensures compliance with industry-specific regulations
• Identifies opportunities to streamline and optimize insurance verification processes
• Provides exceptional customer service throughout the insurance verification process
• Communicates with insurance providers, brokers, or third-party administrators
• Performs quality assurance checks on insurance verification processes
• Handles complex insurance verification cases
• Provides guidance and support to junior employees

Senior Coordinator, Enrollment Operations

Full-stack Engineer

• Designs and defines the technical architecture and infrastructure required for digital solutions.
• Writes code, develops software components, and implements complex functionalities according to project requirements.
• Collaborates with other members of the development team and stakeholders to make high-level architectural decisions, proposes design patterns, and ensures scalability, performance, and maintainability of digital solutions.
• Leverages advanced programming skills to design and implement complex features, optimize performance, and ensure code efficiency.
• Integrates various software components or systems, ensuring seamless communication and interoperability between different parts of the digital solution.
• Writes and executes comprehensive test cases, conducts code reviews, performs debugging, and troubleshoots issues to ensure the reliability, stability, and high quality of digital solutions.
• Participates in agile or other development methodologies, attends meetings, contributes to project planning, and helps drive the progress and success of digital projects.
• Explores new tools, frameworks, and techniques to improve digital solutions and drive innovation within the development team.
• Creates and maintains technical documentation, including system designs, architecture diagrams, code documentation, and other relevant documentation while sharing their knowledge and expertise with team members, ensuring effective knowledge transfer and collaboration.
• Be willing to travel at least 10% of the time to office, conferences, on-sites/off-sites, and other events as needed.

Senior Software Development Engineer

• Provide data technology leadership, oversight, and guidance
• Play a key leadership role in architecture design reviews
• Actively lead and participate in the Architecture community
• Develop Reference data architectures
• Lead and drive proofs-of-concept and technology deep-dives
• Advise and assist App development teams with technical roadblocks