CVS Health

Bilingual

• Responsible for initial review and outreach of new monthly LTC enrollees.
• Outreach and promoting active connection through management of persistent outreach.
• Manages LTC Medicaid Redetermination and Eligibility concerns.
• Receives and compose Service Decision Review tasks for submission to MD.
• Ensures timeliness and efficiency of associated tasks and responsibilities.
• Completes outbound calls to members to obtain confirmation of enrollment and member’s demographics.
• Utilizes Aetna systems to build, research and enter member information, as needed.
• Supports the development and implementation of FL LTC plan.
• Coordinates and arranges Service Decision Reviews for MD review.
• Provides delivery of decision under the direction of MD accordingly.
• Promotes communication to enhance effectiveness of care management services.
• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
• Provides support services to team members by answering telephone calls, researching information, and assisting in solving problems.
• Adheres to compliance with policies and regulatory standards.
• Maintains accurate and complete documentation of required information that meets contractual, regulatory, and accreditation requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Bilingual Care Management Associate

Operations

• Develop and optimize SAS programs and macros to support analytical models and reporting needs.
• Write efficient SQL queries for data extraction, transformation, and analysis.
• Create solutions using Power Apps and automate workflows with Power Automate.
• Collaborate with stakeholders to understand data needs and translate them into scalable solutions.
• Ensure data accuracy, quality, and integrity across all projects.
• Support data governance and documentation best practices.

Senior Analyst, Client Operations

Full-stack Engineer

• Provide strategic leadership and oversee the digital engineering function by managing a team of engineers
• Define technical strategies and roadmaps, ensuring successful project delivery
• Foster a culture of innovation and collaboration within the engineering team
• Create alignment between business goals and technical solutions
• Establish KPIs and OKRs for continuous improvement of digital engineering capabilities
• Collaborate closely with other technical teams to drive technical excellence

Senior Manager – Software Development Engineering

ServiceNow

• Responsible for the development, configuration, integration, and operational support of ServiceNow IT Integrated Risk Management (IRM), Governance, Risk & Compliance (GRC), and Third-Party Risk Management (TPRM) modules
• Partner closely with Risk, Compliance, Security, IT Operations, and business stakeholders
• Deliver scalable, automated, and compliant ServiceNow solutions that support enterprise risk management and service delivery objectives
• Development of approved stories in bi-weekly sprint cadences
• Triage, investigate, and resolve issues in accordance to enterprise SLAs
• Presenting non-standard technical solutions in architecture boards for approval
• Ensure production delivery during releases
• Defect remediation in response to upgrades, incident tickets, and other unplanned events

ServiceNow Risk Engineer

Product Manager

• Define and deliver product roadmaps that align with modernization goals across data, workflow, and patient experience.
• Lead cross-functional teams to translate business needs into scalable technical solutions.
• Develop Data Strategy & Business Insights that support analytics, reporting, and decision-making.
• Collaborate with engineering and architecture teams to ensure data quality, accessibility, and relevance.
• Define metrics and KPIs to measure product performance, business impact, and strategic outcomes.
• Identify opportunities to streamline pharmacy operations through data insights, automation, and system integration.
• Partner with engineering and operations to reduce manual effort and improve fulfillment speed.
• Work with UX and omnichannel teams to enhance colleague and in-store experiences.
• Own and manage the product backlog; ensure sprint readiness and delivery cadence.

Technical Product Lead

Accounts Receivable

• Managing a high volume of medical claims that have denied by refuting the denials within payer guidelines
• Provide representation when needed to internal dept.’s as well as external dept.’s, clients, vendors
• identifying and quantifying trends/issues, developing potential solutions
• Effectively prioritize and manage outstanding refund requests and overpayments
• Identify and implement process efficiencies across the dept.
• Recognize and Identify coding deficiencies and exercise the appropriate action

Senior Coordinator, Revenue Cycle

Analyst

• Effectively perform and document audit activities in accordance with professional standards and the organization’s audit methodology
• Execute testing and create work paper documentation
• Understand procedures, results and business impacts; and document and express such understanding in both written and verbal form
• Perform detail testing as defined by the test program to define, analyze and validate information
• Create clear and accurate documentation and workflows of business processes and testing results and exceptions
• Lead individual project components and testing areas; oversee the work of more junior auditors and/or interns
• Interacts with various levels of Internal Audit and business line management to resolve issues in a timely manner and to maintain effective communications
• Reports related audit findings to audit and business management
• Meets administrative reporting requirements and supports department initiatives
• Demonstrates a commitment to integrity and the company code of conduct, and a respect for diversity and inclusion

Senior Analyst – Internal Audit

• Lead the definition and execution of workforce management strategy for back‑office service operations, adapting WFM principles (forecasting, capacity planning, work allocation, productivity management) to non‑queue‑based environments.
• Identify priority functions for WFM deployment and build roadmaps for progressive capability adoption, balancing near‑term performance improvement with long‑term operating model maturity.
• Translate enterprise workforce strategy into function‑specific models that reflect differences in work type, variability, regulatory constraints, and skill mix.
• Establish demand forecasting and capacity planning methodologies for back‑office workflows (inventory‑based, case‑based, and project‑driven work).
• Implement work‑in‑process, aging, and SLA‑driven management disciplines to improve throughput, predictability, and service outcomes.
• Partner with operations leaders to define productivity standards, staffing assumptions, and performance thresholds appropriate to each function.
• Design a scalable governance framework for back‑office workforce management, including planning cadences, escalation paths, performance reviews, and executive reporting.
• Balance enterprise standardization with functional flexibility, ensuring local operational needs are met while driving consistency in metrics, tooling, and decision‑making.
• Serve as a key influencer in adoption, helping operations leaders embed WFM disciplines into daily management routines.
• Partner with technology and analytics teams to extend or adapt WFM and workflow tools (e.g., work distribution, capacity modeling, analytics platforms) for back‑office use cases.
• Leverage data to generate actionable insights on volume drivers, productivity, staffing efficiency, backlog risk, and service performance.
• Champion use of analytics, automation, and workflow orchestration to improve visibility and reduce manual effort over time.
• Build, lead, and develop a team of workforce management leaders and analysts dedicated to back‑office operations.
• Act as a trusted advisor to senior operations leaders, supporting staffing decisions, vendor strategies, and transformation initiatives.
• Collaborate closely with Finance, HR, and Vendor Management to align workforce plans with budgets, labor strategies, and sourcing models.

Lead Director, Workforce Management – Back Office Operations

Account Executive

• Serve as the senior level liaison for PBM clients
• Interface with Leadership both internally and externally
• Lead the strategic account team with full ownership for client satisfaction and service delivery
• Develop strong internal and client relationships through proactive interactions
• Work collaboratively with internal teams such as medical, account management, clinical, product, operations, and underwriting
• Utilize consultative selling skills to recommend CVS Health solutions
• Develop and deliver quarterly and annual reporting to clients
• Execute client renewals by building relationships with key client stakeholders

• Support Growth Analytics and drive effectiveness of the leadership team
• Communicate key messages and manage key operational workstreams
• Build relationships across Growth Analytics and CVSH enterprise
• Lead special projects including executive-level presentations and impact reporting
• Oversee departmental operations including planning, budgeting, and performance review process

Lead Director, Strategy & Operations – Growth Analytics

Account Manager

• Serves as the primary day-to-day contact for all products and services
• Advocates for the customer’s needs within the organization
• Develops and implements account management strategies
• Builds and maintains strong external and internal relationships
• Achieves customer satisfaction, revenue, membership, and earnings objectives
• Works collaboratively within Aetna and across business functions to ensure customer needs are understood
• Responsible for Customer Relationship Management
• Communicates with internal and external parties
• May require travel to offsite locations for in-person meetings

Senior Account Manager, Northeast National Accounts

Human Resources

• Providing advice, consultation and guidance to leaders and employees on CVS Health policies and practices
• Supporting resolution of employee relations issues while mitigating risks
• Conducting investigations and recommending actions to resolve conflicts
• Developing and implementing employee communication strategies
• Delivering guidance to employees facing personal or professional challenges

Employee Relations Case Manager

Manager

• Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel
• 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 care plans
• 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
• Provide education and preventive guidance for best clinical outcomes
• Monitor member progress and adjust care plans as needed
• Develop proactive strategies to address complex needs and support wellness outcomes

Case Manager, Registered Nurse – Field

• Responsible for managing to resolution appeal scenarios for all products
• Develop into a subject matter expert by providing training and coaching
• Research and resolves incoming electronic appeals as appropriate
• Identify and reroute inappropriate work items
• Assemble all data used in making denial determinations
• Research standard plan design and potential contractual deviations
• Coordinates efforts both internally and across departments
• Identifies trends and emerging issues and reports on potential solutions

Senior Coordinator, Complaint Appeals Operations

• Create and manage reports related to product operations, outcomes, and finances.
• Monitoring targeting processes to ensure the flawless execution of programs.
• Complete analyses and use data to inform decisions on key product features.
• Support the development of briefings and PowerPoint presentations for internal stakeholders and external clients, focusing on product outcomes, strategy, operations, sales/marketing, and finances.
• Take ownership of key product roadmap items by defining strategies or features, conducting feasibility studies and business cases, outlining next steps, executing plans, and collaborating with cross-functional teams such as Operations, Data Science, and Engineering.
• Assist with day-to-day responsibilities to ensure products operate effectively, including addressing client inquiries, identifying, and resolving operational issues, and providing additional support as needed.
• Ensure milestones are met through effective project management and coordination across workstreams, identifying and communicating dependencies and risks.
• Monitor program performance rigorously, proactively resolving issues to ensure flawless execution and continuous improvement.
• Partner with vendors and multiple teams across the enterprise to ensure client satisfaction, operational effectiveness and program financial goals are achieved.
• Develop presentations and briefings for internal and external stakeholders.
• Become a subject matter expert on medication adherence.