CVS Health

Manager

• A Senior Manager of Clinical Innovation is a critical contributor to managing and successfully driving use cases within the clinical innovation portfolio
• Leads, partners, and collaborates with cross-functional teams
• Define, rationalize and align priorities with clearly defined business rationale
• Manage risk, develop interventions and facilitate working sessions
• Supports the evaluation of new concepts and emerging innovation trends

Senior Manager – Clinical Innovation

Business Analyst

• Conduct the annual Health Risk Survey to support needs identification for the member’s Individual Plan of Care.
• Inform the assigned care manager of newly identified health/safety risks or service needs
• Complete care coordination activities delegated by the care manager within an established timeframe.
• inform the assigned care manager and/or associate manager of any identified quality of care issues.
• Passionately support the member’s care coordination needs and drive solutions to address those needs.
• Use problem-solving skills to find alternative contact information for members who are unreachable by care management.
• Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health.
• Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.

Case Management Analyst

Customer Support

• Make outbound calls to members and medical facilities
• Schedule Primary Care Physician (PCP) appointments
• Coordinate communication between members, clinicians, and doctors’ offices
• Present a positive, professional demeanor to clients, health plan members, clinicians, and colleagues
• Use multiple internal and external systems to schedule member appointments and ensure smooth communication between members, providers, and Signify
• Assist health plan members with connecting to a PCP following a health assessment
• Meet department goals for quality, customer service, and productivity (for example, number of calls, appointments scheduled, attendance, and quality targets) in an office or remote environment
• Follow and accurately utilize regulated and client-approved scripts, as well as internal scripts and processes
• Document all member interactions thoroughly and maintain accurate notes and records
• Support warm transfers to and from clinicians, doctors’ offices, and other call center representatives
• Follow departmental procedures when communicating with members, clinicians, and physician offices
• Perform additional tasks as requested by Management
• Support business needs by handling inbound calls, manual outbound calls, and outbound calls initiated by the telephony system
• Serve as a subject matter expert for peers, including side-by-side coaching and assisting with training new or fellow employees
• Accept and respond appropriately to constructive feedback
• Work overtime and participate in on-call rotations as requested
• Protect the security and privacy of all protected health information (PHI) accessed during normal work activities

Member Engagement Customer Service Coordinator – Spanish Speaking

Account Executive

• Develops strong personal and collaborative internal and external relationships to manage book of business to achieve customer and broker satisfaction, revenue, membership, and earnings objectives
• Accountable for building and maintaining strong relationships with a locally-aligned book of business to ensure case renewal and retention
• Determine concerns/barriers for retention of customers; identify top concerns and review mitigation plans with leadership
• Discuss and present solutions and partners with internal partners to enhance customer experience
• Collaborates with account team members and functional support areas on more complex product or service issues to ensure client’s needs are met
• Offers creative program and service solutions to address client’s evolving needs
• Responsible for the financial performance for assigned portfolio including negotiations with Plan Sponsor and Producer
• Reviews and consultatively presents customer reporting with meaningful analytics, trending and insightful recommendations for additional programs and services
• Required to communicate with internal and external parties telephonically and/or in person
• Will require travel to offsite locations for in-person meetings with brokers and clients

Medical Director

• providing clinical expertise to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy
• transactional reviews in support of the appeal process
• clinical claim review process
• predetermination of covered benefits in the Commercial and Medicare environments
• participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve quality and efficiency of health care services
• apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests
• proactively use data analysis to identify opportunities for quality improvement

Medical Director – Medical Policy Ops, DRG

Consultant

• This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky.
• The schedule is Monday-Friday, 8am-5pm with flexibility to work outside of the standard schedule based on business needs.
• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.
• 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.
• Provides triage and crisis support.
• 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 facilitates including effective discharge planning.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates 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 Clinical Consultant – Behavioral Health

Director

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Lead Director, Portfolio Strategy, Commercial Enablement

Financial Planning and Analysis

• Support the development of financial models and strategic frameworks that inform clinical services initiatives and enterprise planning.
• Participate in the preparation and analysis of multi-year capital plans.
• Assist in coordinating the capital investment planning process across the organization.
• Partner with Finance and business leaders to ensure investments align with enterprise priorities.
• Help manage the investment portfolio by contributing to governance processes, compiling performance data, and supporting regular reporting on project status and outcomes.
• Contribute to the preparation of business cases and cost-benefit analyses for new initiatives.
• Collaborate across cross-functional teams and serve as a liaison between business stakeholders, finance, and strategy teams.

Manager – Strategic Financial Planning & Investments

• Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare
• Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning
• Direct provider coordination/collaboration and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes
• Conduct comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues
• Performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to appropriate clinical providers
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits

Behavioral Health Clinical Case Manager – LCPC/LCSW

Program Manager

• Own the end‑to‑end Concur expense process, including submission, audit, approval, and reimbursement workflows
• Maintain and enhance audit rules, configurations, and system controls to ensure policy compliance
• Identify and address process bottlenecks, system issues, and recurring user challenges
• Ensure timely processing and prevent stalled or delayed expense reports
• Serve as the primary point of contact for external supporting partner
• Oversee daily operations, including: Ticket management and resolution, Escalations and issue prioritization, Service‑level agreement (SLA) performance
• Enforce company Travel Expense policy through consistent, structured processes
• Review and resolve policy exceptions, non‑compliant spend, and escalation cases
• Partner with leadership to address repeat exceptions or higher‑risk behaviors
• Support the implementation of controls to reduce misuse and improve policy adherence
• Improve the overall user experience by reducing friction in submission and resolution processes
• Explore and implement automation opportunities, including AI-driven solutions, to enhance expense validation, anomaly detection, and overall process efficiency
• Identify opportunities to improve efficiency, strengthen controls, and enhance system utilization
• Support initiatives to modernize the T&E program, including enhanced reporting, monitoring, and potential new tools or

Travel Expense Program Manager

• Negotiate, execute, review, and analyze contracts and/or handle dispute resolution and settlement negotiations focused on health systems in Indiana
• Manage contract performance
• Contribute to provider compensation and pricing development activities and recommendations, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities
• Optimize interaction with assigned providers and internal business partners to manage relationships and ensure provider needs are met
• Ensure resolution of escalated issues related to claims payment, contract interpretation and parameters, or accuracy of provider contract or demographic information
• Recruit providers as needed to ensure attainment of network expansion and adequacy targets
• Identify and make recommendations to manage cost issues and support cost saving initiatives and/or settlement activities
• Assist with the design, development, management, and/or implementation of strategic network configurations

Senior Manager, Contracting and Network Management

Operations

• Lead and manage the Ad Operations team responsible for managed service campaigns
• Establish and enforce trafficking, QA, and launch readiness standards to ensure accuracy, compliance, and on-time delivery
• Own operational processes for campaign updates, including creative swaps, mid-flight optimizations, and issue resolution
• Develop capacity planning and workflow models to scale managed service execution in alignment with revenue growth
• Partner closely with Activation and Sales teams to ensure smooth handoffs and consistent execution against campaign objectives
• Lead and manage the Support Operations team responsible for self-service advertiser enablement and ongoing support
• Own end-to-end self-service advertiser onboarding, platform readiness, launch support, and post-launch troubleshooting
• Establish and oversee support operations, including ticket intake, triage, escalation paths, and SLA management
• Serve as the senior escalation point for advertiser, agency, and partner issues related to self-service platforms
• Develop scalable documentation, training materials, and enablement resources for internal teams and external customers
• Continuously improve support workflows, tooling, and knowledge management to increase efficiency and advertiser satisfaction
• Lead Tech Operations for CMX’s ad technology stack, including Google Ad Manager and other internal and third-party platforms
• Own technical ad integrations, tagging strategy, and operational readiness for new products, formats, and channels
• Partner with Product and Engineering to test new releases, validate functionality, and ensure operational launch readiness
• Oversee platform administration, configuration, governance, and access management
• Proactively identify and mitigate platform risks, performance issues, and operational dependencies that could impact scale or revenue
• Own processes and partnerships related to brand safety, ad tagging governance, and data aggregation

Lead Director, Marketing Ad Technology Operations

• Provide comprehensive behavioral health care management to facilitate delivery of appropriate quality care and improve program/operational efficiency involving clinical issues
• Provide leadership and day-to-day physician oversight for utilization management team, including the management of high-risk cases and medical necessity decisions
• Participate in the development, implementation, and evaluation of clinical/medical programs
• Provide psychiatric leadership to an interdisciplinary utilization management team, including medical/clinical oversight, consultation and training
• Assist with the development, implementation, monitoring and evaluation of the utilization management program and action plan, ensuring quality and appropriateness of care
• Provide psychiatric leadership for NCQA-compliant clinical quality improvement activities in collaboration with clinical and quality improvement staff

Medical Director – Behavioral Health

Account Manager

• Lead, mentor, and develop a team of Senior Account Managers and Account Managers.
• Set clear performance expectations, provide regular feedback, and conduct ongoing coaching.
• Partner with Industry Managers to oversee Joint Business Planning (JBP) efforts.
• Serve as executive sponsor for key supplier and advertiser relationships.
• Oversee the end-to-end campaign lifecycle, ensuring precision in launch, optimization, and wrap-up.

Director, Strategic Account Management – CVS Media Exchange

• Develop annual brand and media strategies aligned with advertiser goals and growth objectives
• Create campaign strategies and audience targeting recommendations tailored to brand and product lines
• Build strategic supplier growth proposals based on a deep understanding of supplier business goals and marketing objectives
• Serve as the primary liaison for supplier communications, including feedback, approvals, and creative revisions
• Monitor campaign performance using KPIs and data-driven insights to optimize outcomes
• Perform in-depth data analysis to deliver actionable insights and recommendations for short- and long-term media strategies
• Collaborate with sales, merchandising, and internal teams to drive strong results and advertiser satisfaction.