CVS Health

Operations

• analyzing Client's specialty benefit requests and inputting data into RxClaim
• building of new Specialty benefits for clients
• emphasizing data analysis and review of client documentation
• using RxClaim and analytical tools (i.e. MS Excel and MS Access)
• ensuring complete client documentation is included with all requests

Client Operations Analyst

Analyst

• Responsible for the management and resolution of all bank fee management cases
• Contribute to bank fee forecasting process
• Assist with preparation of GL entries supporting the bank fee process
• Prepare responses for quarterly SOX controls
• Communicate with audit through Audit Board
• Ensure compliance with SOX deadlines
• Support the Security Administration team by assisting with the fulfillment of access / entitlement requests
• Track / manage access via team database

Treasury Analyst

Developer Relations

• work within Developer Experience and focus on building and improving platform capabilities that power preview environments and developer workflows
• help teams move faster and safely by enabling them to validate changes earlier in the development lifecycle
• work across the full development lifecycle to deliver scalable, reliable, and self-service solutions that reduce friction in build, test, and deployment processes
• centered around modern web technologies, CI/CD automation (including GitHub Actions), and collaborating with other teams to drive adoption and improve developer tooling

Senior Software Engineer – Developer Experience, Previews Platform

Project Manager

• Serve as a subject matter expert (SME) for CSNP, DSNP, and ISNP products, as well as SRF and HEI programs, influencing quality performance strategies across multiple business areas and functions.
• Leverage SME expertise to manage healthcare quality projects, performance improvement initiatives, and strategic priorities through disciplined project management practices.
• Support decision-making related to the design, development, prioritization, implementation, and evaluation of quality improvement initiatives, including HEDIS, aligned with enterprise strategy, regulatory requirements, and Medicare/Duals/SRF-HEI business goals.
• Analyze key performance data and reporting to identify trends, assess root causes, and inform data-driven business decisions.
• Collaborate with cross-functional stakeholders to drive results, including forming and leading virtual and matrixed teams.
• Effectively communicate and disseminate information across teams and business units to support alignment and improve business performance.

Manager – Healthcare Quality, Project Management

Account Executive

• Develops strong personal and collaborative internal and external relationships to manage book of business
• Accountable for building and maintaining strong relationships with producers/brokers
• Determine concerns/barriers for retention of customers
• Collaborates with account team members and functional support areas
• Offers creative product and service solutions
• Responsible for the financial performance for assigned portfolio
• Reviews and consultatively presents customer reporting

Account Executive – Central Territory

Manager

• Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel as appropriate.
• Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care, community resources, and alternative levels of care.
• Interact with members/clients both telephonically and in person while working on‑site at either location, including meeting with members during inpatient admissions.
• Assess medical, functional, and vocational status to develop and implement individualized plans of care that support optimal health outcomes, benefits eligibility, and timely return to work or baseline functioning.
• Communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers.
• Prepare timely and accurate documentation of all case management activities.
• Collaborate with internal multidisciplinary teams to support optimal member outcomes.
• Conduct outreach to treating physicians and specialists to support appropriate care planning.
• Provide education and preventive guidance to promote best clinical outcomes.
• Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services.
• Monitor member progress toward desired outcomes and adjust care plans as needed.
• Develop proactive strategies to address complex needs and support both short‑ and long‑term wellness outcomes.

Case Manager, Registered Nurse – Field

Pharmacist

• Complete Clinical Reviews and provide a determination of Medicare-Medicaid Coverage Determination/Redetermination
• Responsible for support and input to clinical programs
• Continually monitor the quality and efficiency of the Prior Authorization process
• Provide input to clinical content of new programs
• Complete all annual NCQA, Aetna required and Quarterly IRR training requirements
• Responsible for supporting / providing clinical expertise related to formulary decisions
• Assist Member Services and other internal customers in responding to pharmacy-related inquiries
• Maintain open lines of communication with other functional areas/departments
• Stay current with clinical literature and guidelines

Clinical Pharmacist – AMA Dual

• serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel as appropriate
• implement and coordinate case management activities for catastrophic and chronically ill members
• interact with members/clients both telephonically and in person while working on-site
• assess medical, functional, and vocational status to develop and implement individualized plans of care
• communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers
• prepare timely and accurate documentation of all case management activities
• collaborate with internal multidisciplinary teams
• conduct outreach to treating physicians and specialists
• provide education and preventive guidance to promote best clinical outcomes
• monitor member progress toward desired outcomes

Financial Planning and Analysis

• Lead a team within the Network Finance organization
• Oversee a highly complex Network P&L representing more than $130 billion dollars in pharmacy revenue
• Serve as the primary financial partner to the Network Pricing and Business teams
• Translate network strategy into rigorous financial plans, forecasts, and margin performance insights

Lead Director, FP&A Network

Platform Engineer

• Leading a team of engineers, including hiring, coaching, career development, and performance management
• Setting technical direction and driving architectural decisions for your team's domain, balancing innovation with reliability and maintainability
• Partnering with Product and Architecture to define roadmaps, decompose initiatives into deliverables, and ensure alignment across teams
• Driving operational excellence through investment in observability, incident response, SLOs, and production readiness practices
• Establishing and evolving engineering processes that enable your team to deliver high-quality software at pace — CI/CD, code review, testing strategies, and release management
• Building a culture of ownership, psychological safety, and continuous learning within your team
• Managing delivery across multiple workstreams, removing blockers, managing dependencies, and communicating status and risk to leadership
• Contributing to the broader engineering organization through participation in technical governance, architecture reviews, and cross-team initiatives
• Championing developer experience and engineering productivity improvements that benefit teams beyond your own
• Staying current with industry trends and technologies, evaluating their applicability to our platform and advocating for strategic adoption where appropriate

Senior Manager – Platform Engineering

Consultant

• Responsible for the review and resolution of clinical appeals.
• Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies.
• Independently coordinates the clinical resolution with internal/external clinician support as required.
• This position may support UM, MPO, Coding, or Behavioral Health appeals.
• Full-time telework position with standard hours of Monday–Friday, 8:00 AM to 5:00 PM.

Appeals Nurse Consultant

Product Manager

• Own day-to-day product ownership for a server scrum team supporting the Care Path core train in a SAFe environment
• Lead agile team ceremonies, including backlog refinement, sprint planning, daily standups, sprint reviews, retrospectives, and PI planning preparation
• Translate business direction provided by Product Managers and technical solutions defined with Architecture into features, user stories, and acceptance criteria ready for engineering execution
• Maintain a healthy, prioritized backlog that aligns to portfolio goals, technical dependencies, and delivery timelines
• Partner closely with Engineering and Architecture to clarify requirements, sequence work appropriately, and ensure technical feasibility
• Organize the team around portfolio priorities by helping connect roadmap intent to sprint-level execution
• Support PI planning by driving pre-planning activities, identifying dependencies and timelines, clarifying scope, and surfacing risks early
• Ensure stories are complete and well formed, with strong acceptance criteria, quality expectations, and testing considerations before development begins
• Monitor execution progress, raise blockers quickly, and help drive decisions that keep delivery moving while protecting quality
• Contribute to testing efforts and ensure testing coverage is adequate and shipped product is defect free
• Communicate status, tradeoffs, risks, and readiness clearly across Product, Engineering, and partner teams
• Contribute to continuous improvement in team ways of working, delivery predictability, and backlog readiness

Digital Product Owner

• use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Case Manager, RN

• This position is for a Transition Coordinator for the Transition Team.
• The Transition Coordinator will be assigned to Central and North Cook County Nursing Home and SMHRF to meet with ABH-IL members, to assist with transition to the community.
• Transition Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
• As a Transition Coordinator, they will assist with transition of the members back to the community from the nursing home.
• Identify with members their needs and service needs that may impact member's outcomes.
• Coordinates with the RNCM, BHCM, and the rest of care team to ensure interventions are put into place to support members before and after discharge from the nursing home.
• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilizes 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.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Utilizes case management and quality management processes incompliance with regulatory and accreditation guidelines and company policies and procedures.

Case Management Analyst

• Assists with planning and execution of various strategic, operational, project management, and reporting needs with and for internal constituents.
• Drives solutions and strategic initiatives that enable the Large Group sales and service teams to be more competitive in the marketplace.
• Partner with internal stakeholders and business owners to optimize the achievement of strategic business objectives including profitable growth and improved organizational effectiveness.
• Shares joint accountability for initiative’s return on investment.
• Communicates compelling and concise results to empower client groups in decision making process regarding project opportunities.
• Supports engagements using a disciplined repeatable methodology.
• Designs and develops interventions and facilitates work sessions.
• Develops and delivers all required analysis, reporting, and presentation materials.
• Gathers, analyzes, and synthesizes business intelligence to drive achievement of strategic business objectives.
• Develop communications for leaders and drive end-to-end management processes.
• Proactively identifies opportunities for improvement within assigned initiatives.
• Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer.
• Assists with planning internal and external conferences and events.

Client Operations Analyst

Treasury Analyst

Senior Software Engineer – Developer Experience, Previews Platform

Manager – Healthcare Quality, Project Management

Account Executive – Central Territory

Case Manager, Registered Nurse – Field

Clinical Pharmacist – AMA Dual

Case Manager, Registered Nurse – Field

Lead Director, FP&A Network

Senior Manager – Platform Engineering

Appeals Nurse Consultant

Digital Product Owner

Case Manager, RN

Case Management Analyst

Senior Business Consultant, Large Group COE