CVS Health

Project Manager

• Assist the Lead Director with informatics initiatives focusing on strategic execution, stakeholder alignment, and delivery excellence.
• Translate organizational goals into actionable project plans.
• Manage cross-functional teams to ensure successful implementation of Epic.
• Define and drive execution pathways.
• Develop and maintain risk logs.
• Ensure alignment across clinical, technical, and operational workgroups.
• Deliver concise updates to leadership on status, risks, and decisions needed.
• Partner with training and change management teams to ensure smooth adoption.

Senior Manager of Informatics – Project Management

Analyst

• Responsible for consistently monitoring appeal cases
• Using appeal approved policies, workflows, e-policies, and manuals for all resolution teams and products
• Managing records in a QuickBase database each month

Analyst, Complaint & Appeal Quality

Manager

• Oversee curriculum design for all Epic applications
• Lead instructional design efforts, including development of tip sheets, memos, and educational materials
• Guide Principal Trainers in curriculum development and delivery
• Complete curriculum design to support business requests
• Manage the Epic training environment, maintaining standards, integrity, and coordination
• Serve as the technical and instructional lead for Principal Trainers
• Ensure consistency and quality in training delivery across all domains
• Lead upgrade training initiatives and coordinate training for new implementations and system upgrades
• Oversee user support activities, including pre- and post-live education and incident management
• Partner with Clinical Informatics, IT, Compliance, and operational leaders to align training with workflows, policies, and strategic initiatives

Senior Manager, Principal Trainer Lead

• Develop and execute comprehensive Epic training strategies for new implementations, upgrades, and ongoing education.
• Build and lead Epic training governance across all business units, including documentation standards, training audits, and continuous improvement processes.
• Set the overall approach for training delivery, define ongoing education requirements, and ensure alignment with organizational goals.
• Lead large-scale training implementations, coordinating with external vendors and internal stakeholders.
• Manage training environment build and strategy, including security access and readiness planning.
• Lead training-related change management efforts during system go-lives, upgrades, and workflow redesigns.
• Implement feedback loops to gather and act on stakeholder input, driving adoption and continuous improvement.
• Partner with Clinical Informatics, IT, Compliance, and operational leaders to align training with workflows, policies, and strategic initiatives.
• Facilitate effective cross-functional meetings with clear agendas, follow-ups, and accountability.
• Manage relationships with training vendors and third-party partners to ensure alignment with system updates and certification requirements.
• Deliver executive-level reporting on training status, risks, and decisions needed. Develop and maintain relationships with key stakeholders across the enterprise, presenting and communicating effectively.

Senior Manager, Strategy and Implementations

• Support new Epic implementations and large projects, ensuring alignment with organizational goals and training standards
• Coordinate with external vendors and internal teams for training environment setup and readiness
• Manage upgrade training activities, including content creation, environment updates, and delivery
• Assist in building and maintaining the Epic training environment, ensuring standards, integrity, and security access
• Lead change management efforts for training initiatives, including upgrades and workflow redesigns
• Partner with Clinical Informatics, IT, Compliance, and operational leaders to align training with workflows, policies, and strategic initiatives
• Provide status updates and reporting on training activities, risks, and decisions needed

Manager, Strategy and Implementations, Clinical Informatics Training Team

• Visiting members in their homes to evaluate for appropriateness for waiver services, writing the waiver and submitting for approval
• 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

Case Manager, Registered Nurse - Field

• 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

Case Manager, Registered Nurse – Field

Account Executive

• Develops strong personal and collaborative internal and external relationships to manage book of business
• Accountable for building and maintaining strong relationships with a locally-aligned book of business to ensure case renewal and retention
• Responsible for delivering renewals, cross-sales, up-sales, and growing sales
• Determine concerns/barriers for retention of customers
• Collaborates with account team members and functional support areas
• Offers creative product and service solutions to address client’s evolving needs
• Monitors client’s product lines and services to ensure customer satisfaction
• Responsible for the financial performance for assigned portfolio

• Responsible for oversight of healthcare management staff including the organization and development of high performing teams
• Works closely with functional area managers to ensure consistency in clinical interventions supporting our members
• Accountable for meeting the financial, operational and quality objectives of the unit
• Oversees the implementation of healthcare management services for assigned functional area
• Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards
• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
• May act as a liaison with other key business areas
• May develop/assist in development and/review new training content
• May collaborate/deliver inter and intra-departmental training sessions
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care
• Develop, initiate, monitor and communicate performance expectations
• Ensures the team's understanding and use of information system capability and functionality
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
• Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.

Associate Manager, Clinical Health Services – Behavioral Health

Implementation Specialist

• Manage and coordinate benefit plan implementation for new and existing customers
• Provide focused service, fostering strong relationships with internal business partners
• Analyze and determine if products and services selected by clients are aligned and can be adequately supported by existing systems
• Seek solutions and negotiate essential requirements in support of non-standard plan selections
• Structure the group setups within the Meritain system to align with vendor partners
• Actively consult and communicate with internal staff regarding new business and revision activity
• Complete timely and accurate set-up of complex account structure
• Monitor and manage internal installation process
• Maintain data files for monthly group reporting
• Respond to escalated issues related to group setup
• Assist with the development and testing of new or enhanced group setups
• Provide technical expertise and mentor junior staff members
• Run adhoc data programs to assist with streamlining setup of group and eligibility files

Communications

• Supports the Enrollment Communications Manager role on our Aetna Voluntary Enrollment Communications & Services team.
• Assists with the work and deliverables of multiple enrollment communications campaigns for new and existing customers.
• Develops and maintains a communication toolkit used to provide education to members and potential members of Aetna Accident, Critical Illness and Hospital Indemnity Plans.
• Helps drive participation in those plans through the development of strategic enrollment communications plans.
• Supports initial enrollment and ongoing communication needs.
• Works on special projects throughout the year.
• Internally collaborates with partners in sales, implementation, and account management, and externally with customers and consultants.

Enrollment Communication Coordinator

Recruitment

• Using Workday to accurately track and report out on candidate pipelines and key updates
• Performing pre-screening of candidates in the candidate pipeline
• Responsible for identifying and collaborating with sourcing partners on opportunities to attract candidates and build candidate pipelines
• Ensure customer information is processed efficiently, accurately, urgently, and thoroughly
• Delivering outstanding Talent Acquisition service through a strong commitment to customer needs

Talent Acquisition Specialist

Customer Support

• Actively listen and be an advocate for customers, understand their needs and provide guidance and support
• Resolve customer inquiries and issues efficiently while documenting all interactions
• Educate customers about available resources and assist them in navigating their options
• Anticipate customer needs and provide proactive solutions to enhance satisfaction
• Collaborate with team members and other departments to address service issues and improve outcomes
• Document all customer correspondence and maintain confidential records of patient information
• Follow policies, procedures, and the CVS/Aetna Code of Conduct

Customer Service Representative – Dental

• Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members
• Helps implement projects, programs, and processes for Case Management
• Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area
• Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives
• Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes
• Identifies and escalates quality of care issues through established channels
• Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Delivers influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Assists in encouraging members to actively participate with their provider in healthcare decision-making
• Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution

Case Management Analyst – Field

Consultant

• Applies critical thinking and is knowledgeable in clinically appropriate treatment
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care
• Apply evidence-based standards and practice guidelines to treatment where appropriate
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gathers clinical information and applies appropriate clinical criteria/guideline, policy, procedure and judgment to render coverage
• Coordinates with providers and other parties to facilitate optimal care/treatment
• Identifies members at risk for poor outcomes and facilitates referral opportunities
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
• Consults and lends expertise to other internal and external constituents in coordination and administration of utilization/benefit management function