CVS Health

Consultant

• Responsible for the strategic management, evaluation, and oversight of vendor relationships to ensure optimal performance
• Collaborates with cross-functional teams, monitors vendor performance, and drives process improvements
• Serves as the strategic owner of vendor contracting and ongoing vendor performance
• Monitors vendor performance, ensuring compliance with contractual obligations and service level agreements
• Facilitates collaboration between internal stakeholders and vendors for complex deals and strategic initiatives
• Identifies and resolves process gaps, risks, and issues related to vendor relationships
• Provides regular reporting and updates to leadership on vendor performance, risks, and opportunities
• Supports audits and compliance deliverables related to vendors
• Establishing best practices, templates, and standard work to improve efficiency across markets

Senior Vendor Manager, Dental Business Consultant

Manager

• responsible for overseeing the development, maintenance, and execution of Pharmacy Specialty 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
• Knowledge of utilization management interventions including prior authorization, step therapy, quantity limits, and Specialty Guideline Management UM processes is required
• The leader will feel comfortable partnering in a matrix relationship with colleagues at all levels and teams
• hybrid role, based in-office 3 days/wk with the opportunity to work from home the remaining days.

Senior Manager – Clinical Development, Pharmacist

Analyst

• part of the Optimization group within the Process Excellence & Innovation Team
• focus on improving efficiency and effectiveness of business processes across CVS Finance
• engage internal finance business partners for process improvement
• support reengineering, automation, and related capabilities

Senior Process Analyst

• Dealing with health plan data and trends.
• Collaborate with Meritain's Client Solutions Team leveraging analytics tools.
• Translate data into comprehensive insights and actionable results for employers.
• Proactively offer insights on client plan performance.
• Effectively communicate and collaborate across departments.

Informatics Consultant

• support internal stakeholders, measure and run issue research and resolution
• identify measure and technology opportunities
• provide HEDIS measure data and research to support initiatives
• apply HEDIS measure, data, and technical platform knowledge to perform complex research and analytics in support of internal HEDIS reporting for high profile stakeholders
• apply CVS Heart-at-Work behaviors to work successfully in a team-based environment where team members work together and support each other to achieve greater excellence

Manager, Informatics

• Lead team to develop enterprise-wide and/or cross-functional solutions
• Collaborate across the organization to optimize strategic business objectives
• Coordinate managing day-to-day complex business consultation services
• Assist with the development of processes for data collection and analysis
• Communicate internally and externally regarding organizational goals
• Advise managers on current business trends and best practices
• Administer strategic review processes for continuous improvement
• Design, develop interventions, and facilitate work sessions
• Gather, analyze, and synthesize business intelligence

Business Consulting Manager

• Define and Document Requirements with Clients and Account Managers
• Consult with account teams on proposed solutions to meet objectives and goals including financial and member experience
• Research and analyze impacts for consideration of requirements or errors and provide direction on adjudication setups and solution to configuration and quality teams for mitigation
• Cross functional project support to improve benefits requirements process
• Mentor colleagues within Benefits and Clinical Operations
• Build relationships with key client partners through a consultative approach to understand client benefit plan design needs
• Translate client needs and requirements to internal CVS Health teams such as Benefits Coding and Quality Analysis
• Facilitate internal and external meetings and presentations to provide status updates and make decisions relative to client benefit setup

Senior Analyst, Client Benefits

Medical Director

• Serve as the clinical authority for clinical data definitions and decision logic frameworks
• Build team capability in clinical data science and outcomes measurement
• Serve as the clinical informatics subject matter expert for product teams
• Review and approve clinical-facing content and logic for accuracy
• Partner with Data/Analytics and Data Science teams to define analytical approaches

Senior Medical Director – Clinical Informatics

• Own and manage relationships with multiple external partners including defining roles and responsibilities, setting communication cadence, establishing partnership goals, reviewing performance metrics, and resolving escalations.
• Develop product requirements and roadmaps, integrating customer feedback and market insights into strategic planning.
• Lead decommissioning efforts for underperforming products, including stakeholder communications and customer impact mitigation.
• Analyze customer feedback and market trends to inform product strategy and deliverables.
• Manage development projects aligned with timelines, budgets, and company objectives.
• Identify technical risks and assumptions and recommend contingency plans.
• Collaborate across departments to generate new product ideas and assess feasibility.
• Partner with internal stakeholders, including leadership and cross-functional teams, to ensure alignment and execution.

Senior Manager, Partner Product

• Own the end-to-end strategy and execution for outbound messaging related to order disruptions and fulfillment friction
• Translate disruption scenarios into clear, accurate, patient-friendly messages across channels (e.g., SMS, app push, email) that ensure a consistent experience
• Partner cross-functionally (e.g., Technology, Operations, Pharmacy, Legal/Compliance) to identify friction points, define requirements, and drive fixes
• Establish measurement frameworks and operating cadences to monitor message performance, prioritize new messaging needs and logic changes, and continuously optimize
• Support time-sensitive disruption scenarios and executive escalations during business hours by investigating issues, clarifying patient impact, and driving resolution in partnership with key stakeholders

Manager, Patient Fulfillment Journey

• Analyze complex datasets to identify trends, risks, and improvement opportunities across business operations
• Monitor and report on data quality, performance metrics, and key indicators, ensuring accuracy and timeliness
• Perform root cause analysis and develop data-driven recommendations to address performance gaps
• Design, build, and maintain dashboards, reports, and scorecards for leadership and operational teams
• Develop and enhance automated data validation and monitoring processes to improve efficiency and consistency
• Partner with business owners and subject matter experts to translate requirements into analytical solutions
• Support state-specific and line-of-business initiatives with targeted analytics and insights
• Document methodologies, assumptions, and controls to support auditability and governance expectations
• Contribute to continuous improvement of analytics standards, tools, and best practices

Senior Analyst, Business Analytics

• The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process.
• The Case Management Coordinator facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Analyst, Case Management

Customer Success Manager

• Perform and support plan changes
• Perform ID card facilitation
• Complete necessary reporting (scheduled, ad-hoc)
• Conduct inbound phone calls
• Complete assigned invoices and group terminations
• Complete documentation requests
• Serve throughout the implementation process
• Facilitate and participate in external-facing meetings
• Oversee prior authorization and accessibility processes
• Conduct inbound phone calls for member support
• Oversee resolution of claims issues
• Perform manual eligibility adds and terminations
• Service warranties as assigned

Client Experience Manager

Business Operations

• Lead and manage complex, cross-functional claims and medical management projects from initiation through execution and delivery.
• Serve as a strategic partner to Operations leadership, deeply integrating into business operations to drive impactful outcomes.
• Act as both Project Manager and Business Analyst, analyzing business workflows, policies, and rules to design and implement effective solutions.
• Function as a Product Owner, translating business needs into actionable requirements and overseeing solution development.
• Collaborate closely with IT teams to manage technical project components, ensuring alignment between business goals and system capabilities.
• Develop and maintain detailed project documentation, including project plans, process flows, requirements, and status reports.
• Responsible for managing the budget and/or financial implications of more complex projects
• Utilize data analytics and reporting tools to identify trends, solve problems, and drive continuous process improvement.
• Communicate complex technical concepts in clear, business-friendly language to stakeholders, including internal and external partners.
• Ensure projects are delivered on time, within scope, and aligned with strategic objectives.
• Group facilitation/presentation influencing various internal (these may be cross-functional/segment) and external parties (e.g., vendor management)

Senior Project Manager, Business Operations

Business Analyst

• close collaboration with internal stakeholders and external service partners to support streamlined business operations and effective communication
• analyzing and streamlining existing business processes
• managing escalations and coordinating with stakeholders during outages or technical issues
• creating and maintaining policy and procedure documentation
• navigating SharePoint
• supporting user acceptance testing (UAT) for enhancements related to member and provider communications
• periodic support for Role Based Access Control including reviewing access tickets and gathering information for SOC audits
• performing reconciliations, organizing audits, and working with internal and external auditors to maintain compliance and prevent process gaps