CVS Health Jobs & Careers - Remote Work From Home & Flexible

• San Antonio, TX

Analyze and approve routine claims, apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost containment measures. Route complex claims to Senior Claim Benefits Specialist.

• Toledo, OH

Coordinate events and meetings with community organizations to create brand awareness for Medicare Advantage Plans. Build relationships with Centers of Influence (COIs) to make the company the trusted name in Medicare Advantage in Ohio.

• IA, AZ, IL, KS, FL, IN, KY

Negotiate, execute, and conduct high-level review and analysis of contracts. Recruit providers to attain network expansion and adequacy targets. Collaborate cross-functionally to manage provider compensation and pricing development activities.

• RI, TX, IL, MA, FL, CT, CA

Develop and improve processes for inventory control, data management, asset protection policies, and programs. Lead the COE's IQC organization in core production, audits, cycle count compliance, investigation & security. Standardize policies and proc..

• NY, OH, IL, FL, CT, PA, RI

Manage PBM contract needs, collaborate with stakeholders, lead cross-functional work groups, develop/implement contract language, provide consultative support. Minimum 3 years' contract experience and PBM knowledge required. Bachelor's degree preferred.

• VA, MD, Washington, DC

Manage relationships with providers, optimize interactions, monitor service capabilities, support operational activities. Educate providers on policies and procedures, conduct meetings, collaborate on cost initiatives. Bachelor's degree preferred...

• US National

As a Manager, Business Regulatory Affairs, responsible for reviewing state and federal mandates, engaging senior leaders with implementation status, and driving regulatory compliance with key stakeholders.

• OK, Oklahoma City, OK

Manage and oversee compliance with provider engagement responsibilities, manage local team to deploy national engagement model, co-facilitate provider advisory group and JOC meetings to implement changes via coordination Quality Management.

• US National

Effectively communicate prioritized strategies, progress towards expected financial outcomes, and provide meaningful insights regarding shrink results at the Executive level

• OK

Demonstrated experience with clinical program components, formulary designs, and prescription benefit trends. Experience working in a high production team environment.

• LA

Implement clinical policies and procedures, mentor team members, ensure best practices are followed, manage resources, evaluate data and improve outcomes, recruit and hire staff, create a positive work environment, communicate effectively with stakeh..

• PA

Assess, plan, implement, and coordinate case management activities for members to evaluate their medical needs and facilitate overall wellness. Develop proactive care plans, conduct assessments, collaborate with stakeholders, and utilize case managem..

• OH

Assess, plan, implement, and coordinate case management activities to evaluate the medical needs of members. Develop proactive care plans, conduct assessments, and collaborate with stakeholders to overcome barriers and meet goals.

• US National

Facilitates member healthcare through assessment, care planning, provider coordination, and psychosocial services. Uses Motivational Interviewing and engagement interventions. Completes Comprehensive Assessment and Plan of care. Provides BH consultat..

• Hartford, CT, ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, MI, IN, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, NJ, NY, RI, NH, ME, MD, DE, VT

Lead ServiceNow Integration Engineer: design, implement, and manage integrations between ServiceNow and various enterprise systems and applications. Collaborate with cross-functional teams, provide technical leadership and guidance, troubleshoot and ..

• US National (Not hiring in HI)

Provide consultation and referral services to members and plan sponsors, assess resource needs, research and screen potential service providers, document member interactions, and work in a call center environment.

• US National

Design, develop, and maintain automated solutions for Mainframe Db2 software. Collaborate with software development teams for process improvement and automation. Troubleshoot and resolve database-related issues.

• Woonsocket, RI, Hartford, CT, Scottsdale, AZ, Chicago, IL, Dallas, TX

Provide advice and guidance on company policies, manage grievances and workplace inquiries, assist with coaching, corrective actions, terminations, and serve as a labor relations expert for business unit leaders.

• US National

Provide telephone-based assessment, triage, consultation, counseling, and informational services in a call center. Conduct risk, substance abuse, and mental health assessments, recommend care, and collaborate with teams for positive clinical outcomes.

• HI

Process coverage requests from members or prescribers, conduct outreach to patients and providers, research and correct issues found in the overall process. Ensure decisions are correct and timely while complying with CMS mandated timelines and depar..

• Woonsocket, RI, Scottsdale, AZ, Buffalo Grove, IL

Responsible for techno-functional impact analysis, design, and code construction activities for software development. Manage and support engineers, prioritize tasks, and collaborate with stakeholders to deliver high-quality projects on time and withi..

• Hartford, CT

Define product vision, strategy, and roadmap for HR service delivery within ServiceNow platform. Gather requirements from stakeholders, prioritize features based on business value and urgency, lead sprint planning and manage backlog.

• LA

Assess, plan, implement, and coordinate case management activities to evaluate medical needs of members. Develop proactive care plans, reduce risk factors, and collaborate with interdisciplinary team members to meet goals and objectives.

• VA

Assess, plan, implement, and coordinate case management activities for members. Conduct evaluations, address member issues, and develop proactive action plans to enhance member wellness. Comply with regulatory and company policies.

• US National

Clinical Case Manager Behavioral Health: Utilize clinical judgment and critical thinking to facilitate member physical and behavioral healthcare. Conduct telephonic case management, complete assessments, collaborate with partners, and assist members ..

• Oklahoma City, OK

Provide project management input on business plans, lead assigned projects, organize and communicate project materials, facilitate collaboration with business partners, address project challenges, manage expectations, and support meetings and present..

• US National

Utilize clinical documentation skills to improve the quality and completeness of clinical documentation. Conduct chart reviews, audits, and coding validation to ensure accurate coding and risk score capture. Educate providers on documentation improve..

• SC

Continuously monitor and assess the performance and efficiency of the ServiceNow platform, identifying areas for improvement and optimization. Lead efforts to implement enhancements, upgrades, and new features in line with industry trends...

• Hartford, CT

lead the design and implementation of procurement processes within the ServiceNow platform, including requisitioning, purchasing, vendor management, and contract management...

• US National

Lead technical direction, standards, guidelines, and methodology for specified technologies in the department. Develop and improve strategic technical direction for functional areas. Lead matrixed application technical leads in the development...

• KY, WV

Manage and oversee compliance with Medicaid contractual requirements, develop innovative value-based solutions, negotiate high value contracts, recruit providers, evaluate and implement provider network strategic plans, and collaborate with internal ..

• US National

Telephone-based assessment, triage, consultation, counseling and informational services. Conduct risk, substance abuse and mental health assessments to develop immediate action/safety plans. Collaborate with team for positive clinical outcome and con..

• Woonsocket, RI

Manage and coordinate Virtual TechRx team functions, staff scheduling, and incident resolution. Lead with empathy and kindness while improving operations and customer experience. 5+ years of IT experience required, 3+ years of management experience p..

• NY

Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physicians office to provide ongoing case management services.

• NY

Build influential relationships with partners, stakeholders, and user groups to drive outcomes including platform adoption and satisfaction.

• Phoenix, AZ

Support development and delivery of strategic vision for Vulnerability Management. Collaborate with IT to implement technologies, manage adherence to control standards and security policies, and optimize practices for risk reduction.

• MI, IN, KY, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT, ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, MS, AL

Seeking a Security Engineer with experience in IAM technology solutions, vendor engagement, and coordination of POC rollouts. Must have strong communication skills and knowledge of cybersecurity, BRD documentation, and Microsoft products..

• US National

Lead project management for Medicaid markets, document market activity, manage relationships for market growth, conduct research on new and existing Medicaid markets. 5+ years project management experience and 1+ year Medicaid experience required.

• Hartford, CT, Scottsdale, AZ, Woonsocket, RI, Northbrook, IL, Richardson, TX

Designing and supporting complex contact center solutions and call routing that incorporate technologies such as Cisco Voice and Contact Center, Avaya Voice and Contact Center, Oracle SBCs, IVRs, and Five9 Contact Center as a Service.

• Woonsocket, RI, Scottsdale, AZ, Hartford, CT

Lead the IT technology strategy for Pharmacy domain products, including AI initiatives. Provide technical vision, solve complex problems, and execute across Cloud, backend solution, AIML. Act as executive technical leader and partner with technical...

• US National (Not hiring in HI)

Provide expert guidance to colleagues on a broad range of issues including policy interpretation, colleague performance, and attendance. Respond to inquiries via phone and email, escalate issues when necessary, and provide cross-functional support as..

• US National

Responsible for the development, maintenance, and delivery of iOS applications. Collaborate with cross-functional teams to deliver great user experiences and ensure app performance. Interact and collaborate with IT teams and external vendors.

• AZ

Build strong relationships with key client stakeholders, increase adoption of enterprise solutions, partner in new sales activities and product ideation, and provide leadership on strategic initiatives.

• ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, MI, IN, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT

Design, implement, and maintain ServiceNow Discovery solutions. Configure and optimize ServiceNow Discovery to identify assets and configuration items. Collaborate with cross-functional teams for integration and continuous improvement initiatives.

• ME, NH, MA, RI, CT, NY, NJ, DE, MD, VA, NC, SC, GA, FL

Lead a team of engineers to ensure the observability, reliability, scalability, and performance of systems. Work with cross-functional teams to build observability solutions, maintain and optimize systems, and align with business goals.

• ME, NH, MA, RI, CT, NY, NJ, DE, MD, VA, NC, SC, GA, FL

Ensure observability, reliability, scalability, and performance of systems. Collaborate with cross-functional teams to build observability solutions. Optimize systems and align with business goals. Strong technical expertise and effective communicati..

• US National

Bring your heart to . Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

• Chandler, AZ

Verification Representative, you are a critical liaison between our patients, healthcare professionals and insurance carriers. You will utilize your skills and healthcare industry expertise to efficiently solve insurance-related issues...

• Honolulu, HI

As a Registered Nurse on the Health Management team, you will optimize members' wellness and independence, conduct telephonic health assessments, develop relationships with members, and coordinate quality, cost-effective care with healthcare teams.

• MO

Play an integral role in educating patients with medication adherence and disease state training. As a national leader in the healthcare industry and a Fortune 7 company, we seek special RNs who not only possess strong...