CVS Health

Social Worker

• Partner with a registered nurse case manager in a collaborative process of assessment, planning, and advocacy
• Meet members’ benefit plan and/or health needs
• Research available options and resources for members with financial, transportation, safety, and housing needs
• Provide telephonic and electronic member contact across the entire lifecycle population
• Empower members to make positive lifestyle and medical choices
• Collaborate with clinical staff to assist members with medical, financial, and behavioral health community resources
• Work Monday-Friday 8am-4:30pm EST
• Provide no weekend, holiday, or travel coverage

Nurse

• Assess members through regular in-person or telephonic contact
• Plan, implement, and coordinate case management activities
• Evaluate members’ medical, psychosocial, physical, behavioral, and functional needs
• Develop proactive courses of action to improve short- and long-term health outcomes and wellness
• Use clinical assessment tools and data review to evaluate needs and benefit-plan eligibility
• Apply clinical judgment to reduce risk factors and address complex health and social barriers
• Integrate assessment data from care partners and address comorbidities and multiple diagnoses
• Create, monitor, and revise comprehensive member care plans
• Review prior claims for potential impact on case management and eligibility
• Assess functional capacity and restrictions or limitations
• Refer members to additional clinical resources when needed
• Consult with supervisors and care partners to overcome barriers
• Present cases at multidisciplinary case conferences
• Follow regulatory and company case-management policies and procedures
• Use motivational interviewing to engage members and assess health needs
• Support members in participating knowledgeably in healthcare decision-making
• Work in a field-based environment with productivity and quality expectations
• Travel routinely throughout the Two Rivers Region and attend Louisville office meetings and training

Case Manager, Registered Nurse

Pharmacist

• Work in a leading retail pharmacy company while positively impacting patients’ and customers’ lives and health
• Maintain high professional and ethical standards and comply with Federal, State, and Local laws and regulations
• Help ensure patients’ medication needs and regulatory compliance standards are met
• Demonstrate ethical conduct and maintain patient confidentiality
• Manage assigned pharmacy workstations and tasks
• Support the team in promptly, safely, and accurately filling patient prescriptions
• Provide caring service that exceeds customer expectations
• Complete CVS Pharmacy Technician Training Program as a new Pharmacy Technician
• Build clinical, technical, and insurance knowledge through available tools and training
• Comply with applicable collective bargaining agreement rules in select markets

Pharmacy Technician

• Process prior authorization requests received by phone, fax, or electronically
• Use computer resources, existing criteria, and medication guidelines to perform clinical research supporting prior authorization reviews
• Complete prior authorization approvals and denials due to expire
• Maintain complete, timely, and accurate documentation
• Review potential prior authorization denial language to ensure NCQA requirements are met
• Follow prior authorization workflows, policies, and procedures
• Answer high-volume prior authorization inquiry calls from provider offices, pharmacies, and internal partners
• Communicate prior authorization status or decisions using computer resources
• Balance productivity, quality, and timeliness of work
• Participate in required training, continuing education, and team or departmental meetings
• Work scheduled 8-hour shifts within operating hours of 5:00 a.m. to 8:30 p.m.; overnight shifts may be available
• Complete 40 hours per week, including weekends and holidays when scheduled
• Work extended hours when necessary and participate in a rotating weekend schedule

Pharmacy Technician – Prior Authorizations

Nurse Practitioner

• Conduct approximately 30-minute online Video Visits with Medicare Advantage, Medicaid, and certain commercial plan members
• Review members’ medications and medical histories
• Educate members about their health and answer questions
• Help close gaps in care and connect members to appropriate care
• Provide Video Visits in a private space with adequate internet connection
• Participate in regular manager, team, and clinical meetings
• Meet operational, clinical, and member experience key performance indicators and metrics
• Maintain required training, affiliations, credentials, and compliance
• Interact remotely with health plan members using a computer, phone, iPad, and other electronic devices

Virtual Clinician, Home Evaluations, Nurse Practitioner / Physician Assistant

• Provide in-home health evaluations in members’ private residences
• Conduct approximately 45-minute visits, including medication and medical history review and physical evaluation
• Perform additional diagnostic tests when ordered by the member’s health plan, such as diabetic eye exams and spirometry
• Use an iPad and clinical workflow for each evaluation
• Build trusted relationships and help improve health outcomes
• Visit people nationwide and connect them to appropriate care
• Travel locally and within licensed states as needed
• Conduct virtual visits as needed
• Provide indicated Diagnostic & Preventive Services, including spirometry, diabetic eye exams, and bone density screening

In-Home Nurse Practitioner, Physician Assistant – Part Time

• Support comprehensive coordination of Medicaid and/or Medicare pharmacy services, including intake and processing of pharmacy authorization requests
• Promote and support quality effectiveness of healthcare and Pharmacy Services
• Evaluate, authorize approval, and communicate decisions for pharmacy requests according to clinical guidelines
• Evaluate and authorize pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria
• Determine medication appropriateness and communicate decisions to physicians, physician office staff, medical management staff, members, and pharmacists
• Perform clinical research to support requests
• Perform non-medical research including eligibility verification, COB, and benefits verification
• Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
• Process requests in compliance with laws, CMS regulations, and company policies and procedures
• Communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies, and Health Care Providers
• Promote internal and external communication to enhance medication therapy management services
• Escalate requests to a Pharmacist when extensive clinical review or denial is required
• Perform sedentary work involving significant periods of sitting, talking, hearing, and keying

Representative

• Serve as the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base
• Determine whether complex requests should be transferred to a pharmacist for assistance
• Maintain complete, timely, and accurate documentation of approvals and denials
• Document conversations and outcomes across multiple software systems

Prior Authorization Representative

Technical Project Manager

• Manage resources, schedule and budget across teams
• Design and develop tools and processes for effective team delivery
• Analyze team productivity and quality data to generate actionable insights for improvement
• Develop and execute stakeholder communication strategies to gather feedback and incorporate it into process enhancements
• Implement knowledge-sharing systems such as wikis and documentation platforms
• Act as a liaison between teams and stakeholders, removing obstacles and ensuring smooth delivery
• Create an environment that enables team success, fosters collaboration, and drives continuous improvement

Senior IT Project Manager

Pharmacy Technician, Prior Authorizations

Scrum Master

• Coach Scrum Masters, Product Owners, and Agile teams on Agile principles, Scrum values, and best practices
• Guide teams in self-organization, cross-functionality, accountability, and continuous improvement
• Promote adaptability, transparency, collaboration, experimentation, and a growth mindset
• Establish and implement a common language and framework for Agile team collaboration
• Facilitate and oversee Scrum ceremonies, including daily stand-ups, sprint planning, sprint reviews, retrospectives, and backlog refinement
• Remove impediments and address risks and obstacles affecting productivity and sprint commitments
• Protect teams from external disruptions, scope creep, and competing priorities
• Determine work capacity based on team velocity, capacity, and historical performance
• Forecast team capacity and delivery potential for future initiatives
• Partner with Product Owners on backlog management, prioritization, user story refinement, and product roadmap execution
• Align product goals, business objectives, and customer needs across teams
• Facilitate communication among cross-functional stakeholders
• Ensure risk assessments include identification, mitigation strategies, and contingency planning
• Maintain Scrum processes and procedures
• Identify bottlenecks and workflow inefficiencies and drive improvements
• Use metrics and Agile best practices to improve effectiveness and operational excellence
• Develop budget and resource-planning strategies
• Support Agile work across multiple teams and initiatives
• Ensure effective resource allocation to meet delivery commitments and business objectives

Manager, Scrum Master

Manager

• Negotiate, execute, conduct high-level review and analysis, and resolve disputes or conduct settlement negotiations for contracts
• Manage larger and more complex market, regional, and national provider groups and systems
• Contract and implement fee-for-service and value-based agreements with physician groups, facilities, and ancillary providers
• Collaborate with Aetna and CVS departments to improve physician performance and quality of care
• Recruit providers to achieve network expansion and adequacy targets
• Manage cost arrangements within defined provider groups
• Partner cross-functionally on provider compensation, pricing development, contractual information submission, and reimbursement modeling
• Lead end-to-end contract negotiations, execution, and analysis
• Manage contract performance and develop and implement value-based arrangements
• Identify, recruit, and onboard providers
• Analyze financial and operational data to identify cost-saving opportunities and execute impact-driving initiatives
• Represent the organization with providers, customers, and community stakeholders
• Evaluate and contribute to provider network strategy aligned with state requirements, product needs, and cost management objectives
• Optimize provider engagement and resolve complex escalations involving claims, contract interpretation, and provider data accuracy

Senior Manager, Network Contracting

• Support the pharmacy team in delivering operational and service excellence
• Serve as an initial point of contact for patients and customers
• Follow company SOPs and pharmacy workflow procedures
• Fulfill prescriptions safely, promptly, and accurately across production, pick-up, drive-thru, and drop-off workstations
• Provide empathetic and personalized patient service in person 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, including medication deliveries, cycle counts, returns-to-stocks, and waiting-bin inventories
• Contribute to a high-performing, safe, inclusive, and engaging team
• Travel voluntarily to other stores in the market to work shifts as needed
• Comply with federal, state, and local laws, regulations, professional standards, ethical principles, and CVS policies
• Support additional health care services such as immunizations, point-of-care testing, and offsite clinics where permitted and trained
• Obtain Technician Immunizer status where applicable
• Educate patients about vaccines and refer vaccination questions to the Pharmacist-on-duty
• Monitor and respond to adverse vaccine reactions and report events
• Review and collect patient information and document applicable patients
• Monitor and manage vaccine supplies
• Perform additional tasks as directed by a Supervisor or Manager

Clinical Operations

• Oversee healthcare management staff and develop high-performing teams
• Oversee a non-clinical DE staff
• Ensure consistency in clinical interventions supporting members
• Meet financial, operational, and quality objectives of the unit
• Oversee implementation of healthcare management services
• Implement clinical policies and procedures according to regulatory and accreditation standards
• Mentor the team on practice standards, quality of interventions, problem resolution, and critical thinking
• Implement and monitor best-practice approaches and innovations across the continuum of care
• Liaise with key business areas
• Develop, assist with development, and review training content
• Collaborate on and deliver inter- and intra-departmental training sessions
• Protect member information confidentiality
• Manage resources for member identification, care-plan development and implementation, medical appropriateness, quality of care, monitoring, evaluation, and documentation
• Develop, initiate, monitor, and communicate performance expectations
• Ensure team understanding and use of information-system capabilities and functionality
• Potentially manage an individual caseload
• Serve as a customer and account-team point of contact, including customer meetings and new-customer implementation support
• Participate in staff recruitment and hiring
• Assess developmental needs and implement action plans supporting high-performing teams
• Promote teamwork, cross-product integration, and continuum-of-care thinking
• Lead change efforts as a model change agent
• Foster a positive work environment and support team contributions
• Maintain compliance with policies and procedures

Clinical Operations Supervisor

Consultant

• Review and assess clinical information to support coverage determinations and care recommendations
• Apply clinical guidelines, policies, and professional judgment to utilization management decisions
• Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans
• Identify opportunities for care management referrals and enhanced member support services
• Promote quality outcomes, effective healthcare utilization, and member-centered care
• Serve as a clinical resource for internal and external stakeholders
• Work a 24/7 operation schedule including evenings, weekends, and holidays
• Work from a designated home workspace and comply with work-from-home, security, and HIPAA requirements
• Set up and use multiple monitors and applications
• Communicate via email, calendar invites, Teams, and virtual meetings
• Troubleshoot common technical issues and contact IT for unresolved issues

Social Worker

Case Manager, Registered Nurse

Pharmacy Technician

Pharmacy Technician – Prior Authorizations

Virtual Clinician, Home Evaluations, Nurse Practitioner / Physician Assistant

In-Home Nurse Practitioner, Physician Assistant – Part Time

Pharmacy Technician – Prior Authorizations

Prior Authorization Representative

Senior IT Project Manager

Pharmacy Technician, Prior Authorizations

Manager, Scrum Master

Senior Manager, Network Contracting

Pharmacy Technician

Clinical Operations Supervisor

Utilization Management Nurse Consultant