CVS Health

Call Center Representative

• Conduct outbound calls to patients that qualify for adherence-based programs, ensuring timely and consistent communication
• Address patient concerns, troubleshoot issues, and provide appropriate resolutions, ensuring patient satisfaction and program success
• Identify clinical support needs and escalate calls to Pharmacists on the team to further discuss concerns
• Use CVS Procedures and guidelines to handle patient prescription requests within HIPAA guidelines
• Utilize computer systems, software, and databases to accurately record patient information and interactions
• Maintain confidentiality and adhere to all relevant patient privacy regulations and company policies during all interactions and data handling processes
• Collaborate with cross-functional teams to identify areas for program improvement
• Identify and communicate issues to senior level staff as appropriate

Tech, RX Call Center

Full-stack Engineer

• Architect and deliver enterprise AI platform capabilities including workflow orchestration engines, multi-provider LLM integration, and automated deployment pipelines that enable healthcare teams to build and deploy AI applications at scale
• Design multi-tenant infrastructure with automated provisioning, namespace isolation, and role-based access control to support secure, per-team dedicated environments across the platform
• Build backend services and APIs for workflow authoring, execution orchestration, and platform observability using cloud-native patterns on Kubernetes infrastructure
• Implement production observability and reliability practices including distributed tracing, performance monitoring, and incident response for platform health and cost management
• Drive technical architecture decisions across the platform, mentor engineers on design patterns, security best practices, and operational excellence
• Partner with business stakeholders, product teams, and engineering leadership to align platform roadmap with healthcare automation objectives and adoption strategy
• Champion security posture including secrets management, audit logging, compliance requirements, and production readiness standards

Staff Software Development Engineer – NodeJs, AI

Manager

• work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients
• application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs
• apply clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators
• assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality
• consult with supervisor and others in overcoming barriers in meeting goals and objectives
• present cases at case conferences for multidisciplinary focus
• consult with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives
• utilize case management processes in compliance with regulatory and company policies and procedures
• utilize motivational interviewing skills to ensure maximum member engagement
• identify and escalate member’s needs appropriately following set guidelines and protocols
• actively reach out to members to collaborate/guide their care
• perform medical necessity reviews

Case Manager, Registered Nurse – Oncology Experience Required

• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes
• Responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality
• 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 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

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

Operations

• Analyzes workload patterns, forecast resource needs, and make recommendations for adjustments or enhancements at the regional level
• Monitors and leads strategy on operational performance metrics and key performance indicators (KPIs) to assess the efficiency and effectiveness of operations
• Manages direct reports to identify and solution for opportunities for process improvement within the operations support functions through workflow analyses
• Addresses escalated customer or client concerns, investigates operational incidents, and works with relevant stakeholders to identify root causes and implement corrective actions
• Establishes and enforces compliance guidelines and quality control processes including implementing quality assurance programs
• Drives initiatives, implements process improvement initiatives, and measures the impact of changes to improve operational compliance across cross-functional stakeholders
• Facilitates effective communication across regional operations support teams and with other stakeholders
• Fosters a culture of continuous improvement within the operations team by encouraging innovation, gathering feedback from employees, and implementing initiatives to enhance operational effectiveness and customer satisfaction
• Accountable for ongoing training and skill development to ensure all team members are fully versed and compliant within their respective roles
• Other duties as assigned

Senior Manager, Clinician Operations

• Analyzes workload patterns, forecast resource needs, and make recommendations for adjustments or enhancements at the regional level
• Monitors and leads strategy on operational performance metrics and key performance indicators (KPIs) to assess the efficiency and effectiveness of operations
• Manages direct reports to identify and solution for opportunities for process improvement within the operations support functions through workflow analyses
• Addresses escalated customer or client concerns, investigates operational incidents, and works with relevant stakeholders to identify root causes and implement corrective actions
• Establishes and enforces compliance guidelines and quality control processes including implementing quality assurance programs
• Drives initiatives, implements process improvement initiatives, and measures the impact of changes to improve operational compliance across cross-functional stakeholders
• Facilitates effective communication across regional operations support teams and with other stakeholders
• Fosters a culture of continuous improvement within the operations team by encouraging innovation, gathering feedback from employees, and implementing initiatives to enhance operational effectiveness and customer satisfaction
• Accountable for ongoing training and skill development to ensure all team members are fully versed and compliant within their respective roles

Senior Operations Manager

Business Analyst

• Consult with business and technical personnel to elicit business, functional and non-functional requirements for specified applications.
• Analyze the feasibility of and develops requirements for new systems and enhancements to existing systems.
• Track and fully document changes for business and functional specifications as per department change control processes.
• Designs screen mockups for requirements documentation to assist development teams in building screens and changing existing system screens.

Technical Business Analyst

• Assist in tracking IT application and software using inventory tools.
• Help ensure assets comply with company policies and licensing requirements.
• Log and categorize IT issues using ticketing systems.
• Communicate with team members and users during incident resolution.
• Participate in investigations to understand recurring issues.
• Help document known problems and solutions in a shared knowledge base.
• Assist in documenting planned changes to systems and applications.
• Help maintain documentation for backup and recovery procedures.

IT Production Operations Analyst

Consultant

• Translate complex benefit information into easy-to-understand plan language for self-funded plans.
• Analyze, draft, edit and review all legal and regulatory plan documentation for self-funded plan customers.
• Ensure compliance with federal and state law.
• Negotiate deadlines and influence change to improve information quality, availability, and access.
• Deliver high-quality documentation meeting department standards and correct errors in spelling, grammar, and formatting before sending to the customer.
• Participate in implementation of department projects as needed.

Benefit Consultant

• Set and influence strategy for health plan medication adherence solutions
• Identify and evaluate new ideas to improve medication adherence
• Assess and size new opportunities using qualitative and quantitative insights
• Build business cases and recommendations to support investment decisions
• Lead individual workstreams and manage projects from idea through execution
• Partner with cross‑functional teams to align priorities and drive results
• Support development of multi‑year strategic roadmaps
• Prepare clear insights, presentations, and updates for senior leadership
• Track progress and communicate outcomes, risks, and learnings

Manager, Health Plan Adherence Solutions – Strategy and Innovation

• Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities
• Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work
• Acts as a liaison with member, family, provider(s), insurance companies, and healthcare personnel as appropriate
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care
• Interacts with members/clients telephonically
• Assesses and analyzes injured, acute, or chronically ill members medical; develops a plan of care to facilitate the member appropriate condition management to optimize wellness and medical outcomes, or optimal functioning

Case Manager – Registered Nurse

Accounting Manager

• responsible for providing accounting support and financial planning and analysis for the Corporate Controllers and Rebates Department
• responsible for maintaining sub-ledgers, performing monthly reconciliations of client payable accounts
• processing adjustments in the Rebate System
• ensuring balances are in sync with Manufacturer A/R
• performing internal control testing of certain Rebates functions in compliance with SOX
• preparing monthly client profitability analysis
• preparing monthly rebate booking files and Journal Entries
• explaining variance drivers

Accounting Analyst

• 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.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical 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 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.
• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

Utilization Management Clinical Consultant

Account Executive

• Managing sales growth by building a book of business leveraging field sales marketing activity and telesales programs
• Selling, cross-selling, up-selling, and retaining through the use of the Aetna IVL Medicare product portfolio
• Owning the member relationship throughout the year and being the primary contact for member inquiries
• Documenting in the hybrid field sales integrated tech stack call interactions, COIs, and lead management protocols with new and existing members
• Developing, continuously training, and learning new sales skills to support best in class customer acquisition metrics