CVS Health

Manager

• Oversee Integrated Care Management (ICM) and Long-Term Services and Supports (LTSS) healthcare case management staff
• Progress initiatives for high-performing health service teams
• Collaborate with Health Services managers to ensure consistency and accuracy in clinical interventions
• Complete tasks supporting financial, operational, and quality objectives
• Serve as a key resource for healthcare members regarding governmental, state, local, and legal initiatives, including COBRA, EMTALA, and Medicare regulations
• Implement and sustain Clinical Health Services policies, procedures, action plans, initiatives, and strategies
• Provide application expertise to Health Services account managers to support client retention and resource utilization
• Partner with patient resources, divisional management, Clinical Education, and other departments to evaluate performance initiatives and recommend training
• Implement change management plans for new or enhanced initiatives
• Facilitate regular staff meetings on policies, procedures, and expectations

Associate Manager, Clinical Health Services

Product Manager

• Lead software product management for CVS Health’s Security Automation portfolio within Enterprise Information Security
• Partner with the Lead Director, Security Automation to run an engineering and product portfolio pairing
• Apply commercial-grade product management to internally built security products
• Conduct continuous discovery with security operations analysts, GRC and audit teams, identity and infrastructure engineers, application teams, and enterprise colleagues
• Translate workflow pain into prioritized roadmaps and define product outcomes
• Own internal go-to-market, enablement, documentation, onboarding, adoption measurement, feedback channels, and product lifecycle decisions
• Lead, coach, hire, level, and develop a team of product managers
• Set standards for discovery, problem framing, requirements quality, and outcome measurement
• Own portfolio strategy, vision, multi-year roadmap, product discovery, adoption, requirements, and engineering delivery partnership
• Define and instrument adoption, usage, effort reduction, cycle-time reduction, support deflection, and risk-reduction measures
• Partner on build-versus-buy and commercial evaluations, including market, vendor, licensing, and total-cost-of-ownership analysis
• Communicate roadmap, tradeoffs, progress, and outcomes to stakeholders, senior leadership, and executive sponsors
• Own business cases, benefit quantification, ROI, payback analysis, and financial framing for investments
• Establish and mature product management practices, prioritization mechanisms, discovery standards, roadmap communication, documentation standards, and supporting tools

Lead Director, Software Product Management

Paralegal

• Support one or more attorneys on the Pharmacy Benefit Management (PBM) contracting team
• Work on legal contract documents
• Draft document versions from templates for attorney review
• Process subsequent document versions with client or consultant revisions
• Incorporate comments and edits from internal partners
• Assist with intake, tracking, and administration of open contract files

• Coordinate all case management activities with members to evaluate medical needs
• Facilitate the overall wellness of members
• Develop strategies to address issues, outcomes, and opportunities to enhance members' overall wellness through integration
• Instruct programs and procedures in compliance with network management and clinical coverage policies
• Travel within 125 miles round trip for 1 day in the field
• Work variable schedules, including 2 days weekly until 9pm local time

Case Manager, RN – Field

• Coordinate all case management activities with members to evaluate medical needs
• Facilitate members' overall wellness
• Develop strategies to address issues, outcomes, and opportunities to enhance members' wellness through integration
• Instruct on programs and procedures in compliance with network management and clinical coverage policies
• Travel within 125 miles round trip for 1 day in the field
• Work a variable schedule, including 2 days weekly until 9pm local time
• Achieve performance metrics and maintain compliant documentation

Case Manager, RN - Field

Business Analyst

• Create new MAC lists and manage existing MAC lists
• Upload MAC prices to the adjudication platform
• Perform MAC-related quality control processes
• Collaborate with the Finance Guarantee team to help ensure client commitments are met
• Make MAC adjustments as appropriate and as needed
• Review and respond to pharmacy MAC appeals
• Work with the Legal team to respond to MAC-related complaints from state agencies
• Monitor pharmacy GER guarantees
• Prepare MAC-related reporting, including client and pharmacy reports

Associate Business Analyst

• Coordinate all case management activities with members to evaluate medical needs
• Facilitate the overall wellness of members
• Develop strategies to address issues, outcomes, and opportunities to enhance members' overall wellness through integration
• Instruct on programs and procedures in compliance with network management and clinical coverage policies
• Travel within 125 miles round trip for 1 day in the field
• Work a variable schedule, including 2 days weekly until 9pm local time
• Achieve performance metrics and maintain compliant documentation

Scrum Master

• Carry out and facilitate Scrum events
• Remove impediments and promote collaboration
• Support the Product Owner
• Drive continuous improvement
• Ensure effective implementation of the Scrum framework
• Counsel Scrum Master teams on agile principles and values
• Interpret agile metrics and reporting frameworks to track and report key information and monitor team progress
• Design and develop process evaluation tools to assess Scrum principle application
• Develop actionable insights from analytics and report on team productivity, velocity, and quality
• Develop stakeholder communication strategies and incorporate feedback into process improvements
• Facilitate the Scrum process and support the Scrum team
• Implement sharing and documentation systems using wikis, documentation platforms, or knowledge management tools
• Instruct team members and stakeholders on agile values, principles, and practices
• Interface with teams, stakeholders, and external stakeholders to help address potential obstacles

Senior Manager, Scrum Master

• Collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members
• Provide care coordination, support, education, coaching, and information to members
• Evaluate members’ needs and eligibility and recommend case-resolution approaches
• Evaluate benefit plans and available internal and external programs/services
• Identify risk factors and service needs and refer to clinical case management or crisis intervention as appropriate
• Coordinate and implement assigned care plan activities and monitor progress
• Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
• Present cases at case conferences for multidisciplinary review
• Identify and escalate quality-of-care issues
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs
• Use motivational interviewing to promote member engagement and lifestyle/behavior changes
• Help members participate knowledgeably in healthcare decision-making
• Apply case management and quality management processes in compliance with regulatory, accreditation, and company requirements
• Travel to meet members face to face in the Danville, Virginia region

Case Management Analyst - Field

Nurse

• Assess, plan, and coordinate comprehensive care for members with diverse medical and behavioral health needs
• Conduct in-depth, face-to-face assessments to identify member needs
• Develop and implement individualized care plans
• Coordinate medical, behavioral, and community-based services
• Monitor progress and adjust care strategies to improve outcomes
• Advocate for members to ensure access to high-quality, appropriate care
• Integrate services and address barriers to care
• Connect members with appropriate healthcare and community resources
• Build relationships with members through in-person visits
• Collaborate with interdisciplinary teams, providers, and support networks
• Work autonomously while coordinating proactive, member-centered care

Case Manager Registered Nurse – Field

• Coordinate all case management activities with members to evaluate medical needs
• Facilitate the overall wellness of members
• Develop strategies to address issues, outcomes, and opportunities to enhance members' overall wellness through integration
• Instruct programs and procedures in compliance with network management and clinical coverage policies
• Travel within 125 miles round trip for 1 day in the field
• Work a variable schedule, including 2 days weekly until 9pm local time

Medical Director

• Provide oversight for medical policy implementation
• Participate in the development, implementation, and evaluation of clinical / medical programs
• Expand Aetna's medical management programs to address member needs across the continuum of care
• Support Medical Management staff in providing timely and consistent responses to members and providers
• Oversee utilization review and quality assurance
• Conduct predetermination reviews and review claim determinations
• Perform Prior Authorization, Pre Certification, Concurrent Reviews, Peer to Peer Calls, First Level Appeals, Special Projects, and Committee participation as needed
• Provide clinical, coding, and reimbursement expertise
• Direct case management when necessary
• Provide clinical expertise and business direction in support of medical management programs
• Act as lead business and clinical liaison to network providers and facilities

Analyst

• Design, build, and maintain Healthy Planet registries, care plans, care teams, and health maintenance topics
• Configure and optimize risk stratification tools, care gap identification, and outreach workflows within Healthy Planet
• Lead testing and validation of Healthy Planet builds
• Design and maintain care coordination workflows for transitions of care, discharge planning, referral management, and care team communication
• Optimize Care Everywhere and interoperability workflows
• Partner with care management and case management teams to streamline documentation, task management, and communication tools within Epic
• Serve as the primary Epic liaison for Population Health, Care Management, and ACO stakeholders
• Translate program goals into technical requirements
• Facilitate workflow design sessions with clinical and operational leadership
• Present build recommendations, timelines, and trade-offs to leadership and governance committees
• Mentor junior and mid-level analysts
• Review and validate build work before release
• Contribute to documentation, standard operating procedures, and onboarding materials
• Partner with reporting teams to support accurate dashboards and quality/outcomes reporting
• Participate in change control, release planning, and regression testing
• Maintain documentation of workflows, build configurations, and design decisions
• Manage and groom user stories and backlog items in agile tools such as Rally

Senior Epic Analyst – Care Coordination

Consultant

• Review authorization requests across a broad range of medical specialties
• Evaluate medical necessity using clinical records, evidence-based guidelines, and benefit plan requirements
• Apply InterQual, MCG, or similar clinical criteria to support authorization determinations
• Collaborate with providers, care managers, medical directors, and interdisciplinary teams
• Ensure compliance with health plan policies, regulatory requirements, and clinical standards
• Manage a high-volume caseload while meeting productivity, quality, and turnaround-time expectations
• Support effective healthcare utilization and positive member outcomes
• Work remotely from a designated home workspace

Concurrent Review UM Nurse Consultant

Pharmacist

• Support the pharmacy team in delivering operational and service excellence within the store
• Assist patients and customers and provide an exceptional experience
• Ensure prescriptions are filled promptly, safely, and accurately
• Follow company SOPs and pharmacy workflow procedures at production, pick-up, drive-thru, and drop-off workstations
• Serve patients with empathy and genuine care at pick-up, drive-thru, and over the phone
• Offer immunizations and other services at the register and over the phone, where permitted
• Solve or escalate patient problems
• Complete inventory activities such as putting away medication deliveries, cycle counts, returns-to-stocks, and waiting-bin inventories
• Contribute to a high-performing, safe, inclusive, and engaging team
• Expand clinical and technical knowledge and respond to feedback
• Remain flexible for scheduling and business needs, including voluntarily traveling to nearby stores for shifts
• Comply with pharmacy laws, regulations, professional standards, ethical principles, and CVS policies
• Deliver additional health care services such as immunizations, point-of-care testing, and staffing offsite clinics when allowed and properly trained
• Where permissible, support immunizations by obtaining Technician Immunizer status, educating patients, monitoring adverse reactions, documenting patient information, and managing vaccine supplies
• Perform additional tasks directed by the Supervisor or Manager

Associate Manager, Clinical Health Services

Lead Director, Software Product Management

Paralegal

Case Manager, RN – Field

Case Manager, RN - Field

Associate Business Analyst

Case Manager, RN – Field

Senior Manager, Scrum Master

Case Management Analyst - Field

Case Manager Registered Nurse – Field

Case Manager, RN – Field

Medical Director

Senior Epic Analyst – Care Coordination

Concurrent Review UM Nurse Consultant

Pharmacy Technician