CVS Health

Account Manager

• Develops working relationship with client contacts to ensure renewal of case and retention
• Executes tactical components of account team's business plan for customer
• Collaborates with account team members and functional support areas on services or complex product issues
• Collaborates with team members on client installation

Account Manager – Self-Funded

Program Manager

• Joining the plan sponsor's wellbeing team in designing, facilitating and evaluating effectiveness of wellbeing programs that educate and influence employees at the worksite to lead healthy lifestyles.
• Leading planning and implementation of onsite biometric screenings, working with screening vendor, and plan sponsor wellness team including wellness champions.
• Auditing participation at each screening location and create plan to increase number of events and employee participation at events.
• Attending onsite biometric screenings and guide members towards healthy lifestyle behavior changes in wellbeing areas including nutrition, physical activity, weight management, stress management, tobacco cessation.
• Establishing rapport with plan sponsors, engage 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 recommendations on delivery and coordination of wellbeing programs, community and vendor programs, and monitor effectiveness of the program.
• Providing monthly reports and monitoring 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, Aetna Care Management programs and community resources as appropriate.
• Performing research on relevant topics in health promotion and disease prevention, as required for specific customers.
• Creates and delivers 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 including wellness service providers.
• Being organized, detailed, consistent, holding themselves and others accountable to reasonably meet customer's expectations.
• Traveling to multiple plan sponsor locations for onsite events and presentations, annual benefits and health fair support, and other school district meetings and events including Tampa, Plant City, and all areas of Hillsborough County which may include some weekends and evenings.

Wellness Program Manager

Analyst

• Understand data requirements
• Use SAS to process and create submissions
• Edit and format data received to comply with submission guidelines
• Create and maintain datasets, data retrieval, validation and analysis
• Audit trail documentation and reconciliation
• Interact with vendors, providers, and internal constituents
• Work in a team environment to effectively manage workflow and achieve commitments

Informatics Analyst

Manager

• The Care Manager—Registered Nurse coordinates care for members with chronic medical and behavioral health conditions
• Conducts comprehensive assessments to evaluate members’ needs
• Addresses social determinants of health by connecting members with appropriate resources
• Develops and implements individualized care plans
• Monitors member progress and advocates for necessary services
• Collaborates with interdisciplinary care team for optimal health outcomes
• Ensures accurate documentation of assessments and interventions
• Participates in team meetings to discuss member status and care strategies

Case Manager, Registered Nurse – Licensed NY RN

• Aetna’s Manager, Capture Strategy & Analysis plays a critical role in supporting the capture (proposal preparedness) and proposal lifecycle.
• Responsible for directing in-depth market, customer, and competitor research to inform capture strategy and proposal development, impacting success rate on multi-billion-dollar procurements.
• Develops actionable insights from market research that inform strategic decision-making, drive customer-centric approaches, and contribute to organizational growth and success.
• Collaborate with the Capture Director and critical business partners, including consultants, to develop documents and tools for each assigned opportunity; including research reports, customer and competitor analyses, capture workshop deliverables, and other identified deliverables.
• Organizes and maintains research outputs in SharePoint, ensuring key insights and source materials are easily accessible to proposal writers and key stakeholders.
• Tracks progress and ensures timely completion of deliverables, directly impacting business growth and development goals.

Manager, Capture Strategy – Analysis

Customer Support

• Determine the purpose of call by actively listening and interacting with callers; triage call in a professional and timely manner
• Assess client needs; research and articulately communicate information regarding pertinent EAP/Worklife services and resources
• Use screening tools to identify where urgent clinical intervention is needed, and transfer calls appropriately, including for members in crisis and at risk
• Perform appropriate research in internal databases and online, in order to identify potential providers and resources
• Enter member information into the appropriate EAP system, in order to initiate the case; document comments and information thoroughly and professionally
• Communicate effectively with all internal stakeholders
• Utilize relevant Aetna databases to research and identify validated, appropriate member resources
• In the appropriate EAP system, maintain an inventory of materials
• Provide miscellaneous support functions, including administrative support, follow-up calls, and other duties as assigned
• Maintain compliance with policies and regulatory standards
• Protect the confidentiality of member information and adhere to enterprise policies, as well as EAP and Worklife policies and procedures
• Maintain accurate and complete internal documentation of required information that meets risk management and regulatory requirements
• Proactively listen to members and anticipates their needs, taking full ownership of each member interaction
• Address inquiries and resolve issues as a "single-point-of-contact" based on phone calls & digital and written correspondence
• Provide customized interaction based on customer preference and individualized needs
• Resolve complex issues without or with limited management intervention
• Administer structured pre-screening assessment based on triggers, in order to assure urgent needs are directed appropriately
• Identify triggers for additional resources and support connections to such responses
• Assess for social determinants/needs & offers, and connect members with viable resources to address those needs.

Employee Assistance Program Customer Support Associate

Consultant

• Responsible for intake, investigation and resolution of appeals, complaints and grievances scenarios for all products
• Ensure timely, customer focused response to appeals, complaints and grievances
• Identify trends and emerging issues and report and recommend solutions
• Review and resolve clinical documentation, clinical complaints and appeals
• Independently coordinate clinical resolution with internal/external clinician support as required

Appeals Nurse Consultant

Operations

• Support initiatives aimed at optimizing talent and vendor resources within the Aetna Technology Team.
• Assist in building and enhancing the Aetna Technology talent pipeline by promoting diverse talent strategies and coordinating hiring processes.
• Develop and deliver comprehensive analysis, metrics, and reporting materials to enable effective decision-making.
• Develop innovative tooling solutions and leverage data visualization tools to communicate insights effectively.
• Integrate requests from multiple teams to provide comprehensive support for data and operational requirements.
• Partner with the Internal Communications Lead to maintain and execute a content management and maintenance plan.
• Support planning and execution of internal events, such as Town Halls and Leadership Events.
• Manage complex information, gather and analyze business intelligence, and communicate findings clearly.

Senior Analyst, Operations Strategy

• Responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating case management activities with members
• Evaluate the medical needs of members to facilitate overall wellness
• Manage a caseload that includes supportive and medically complex members
• Develop proactive courses of action to address issues to enhance outcomes
• Determine appropriate services and supports due to member's health needs including prior authorizations, coordination with PCP and skilled providers, condition management information, medication review, community resources and supports

Analyst, Case Management – Field

IT Support

• Processing PBM vendor invoices and claims
• Imports and monitors PBM claim data and invoice files
• Reconciles and balances claims data and invoices in the claims processing system
• Coordinates client billing and invoice payments
• Communicate invoice processing errors/delays to client management
• Maintain invoice tracker by keeping assigned book of business up to date
• Manage special accommodation products as required

Pharmacy Benefit Manager, Invoice Processor

• Overseeing the development, maintenance, and execution of utilization management programs.
• Includes both the clinical content of the programs as well as the operational actions needed to ensure the programs are implemented correctly.
• Comfortable partnering in a matrix relationship with colleagues at all levels and teams.

Senior Manager – Clinical Development, Pharmacist

Financial Planning and Analysis

• Prepare various statutory finance deliverables, including quarterly, annual and audited financial statements and related supplementary filings to the regulatory agencies
• Perform various financial analytics on legal entities’ financial results to understand unexpected fluctuations
• Network with various business partners to understand the underlying drivers and future expectations for the entities
• Assist in the transformation of CVS Health’s financial reporting processes to an automated, stream-lined state

Analyst, Statutory Financial Reporting – Analysis

• Collaborate with an interdisciplinary care management team to support members on their path to better health
• Conduct comprehensive medication reviews and telephonically outreach patients
• Identify and resolve medication related interventions
• Oversee pharmacy technicians for pharmacy benefit and precertification issues
• Participate in case conferences and plan sponsor requested formal clinical assessments
• Enhance clinical knowledge through rounds and collaboration with colleagues

Pharmacist – Pharmacy Program Manager

• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes
• Conducts an evaluation of member’s needs and benefit plan eligibility
• Facilitates integrative functions and smooth transition to Aetna programs and plans
• Applies clinical judgment to reduce risk factors and address complex health and social indicators
• Utilizes interviewing skills to ensure maximum member engagement

Case Manager, Registered Nurse (RN)

Actuary

• Support the actuarial pricing of Aetna Funding Advantage (AFA)
• Own pricing recommendations for one of the regions where AFA is sold
• Develop strong subject matter expertise on AFA’s new business and renewal pricing models
• Drive efficiency through process improvement
• Develop and maintain a robust suite of financial reports