CVS Health

Solutions Engineer

• Architect and design Epic Healthy Planet, Reporting Workbench, Clarity/Caboodle, and SlicerDicer solutions supporting Medicare Star Ratings, HEDIS, and NCQA measure tracking and gap closure
• Translate quality measure specifications into functional and technical Epic build requirements
• Design scalable data models and reporting frameworks for quality measure calculation and Star Ratings monitoring
• Own the technical roadmap for Epic STARS-related builds, including registries, care gap alerts, BPAs, and health maintenance topics
• Partner with Quality, Population Health, ACO, and clinical leadership to translate business needs into Epic solutions
• Serve as technical liaison between clinical quality teams and Epic build/development teams
• Collaborate with analytics and reporting teams on accurate, timely quality measure data feeds aligned with CMS requirements
• Present architectural recommendations, risk assessments, and solution options to senior leadership and governance committees
• Lead or oversee Epic builds involving registries, health maintenance plans, documentation flowsheets, and quality dashboards
• Evaluate workflows and recommend optimizations to improve Star performance
• Ensure interoperability between Epic and external quality reporting platforms using FHIR/HL7 where applicable
• Conduct testing, validation, and troubleshooting of quality measure logic
• Maintain documentation of architecture, data flows, and build decisions for audit readiness and knowledge continuity
• Ensure compliance with CMS, NCQA, and internal data governance standards
• Participate in change control and release management
• Track CMS Star Ratings, HEDIS, and Epic Healthy Planet updates
• Identify opportunities to use new Epic functionality to improve Star Ratings outcomes
• Mentor junior analysts and build staff on Epic quality measure architecture best practices

Solution Architect – Epic STARS

Analyst

• Support Resource Planning functions for multiple Clinical programs within Clinical Operations to ensure appropriate staffing by department
• Monitor Five9, MHK, People Safe, cloud-based or predictive dialers for inbound and outbound calls
• Adjust staff, workflow, skills, and schedules to ensure service levels and performance goals are met
• Create and maintain data in CMS, Five9, Verint WFM, NICE, and other applicable databases
• Research and support operational staffing adjustments to maximize employee efficiency
• Assist with forecasting and scheduling call center phone, offline, back-office, intraday, and real-time functions in multi-skill/multi-site environments
• Monitor Avaya CMS, Five9, CAS offline queues, MHK, People Safe, Verint WFM, NICE, Aspect, Avaya Predictive Dialer, and CAS volumes
• Monitor employee adherence to schedules
• Participate in and present at ad hoc, daily, weekly, and quarterly meetings regarding workflow, scheduling, forecasts, and staffing changes
• Provide and maintain reports and data in CMS, Verint WFM, and other applicable resources
• Maintain professional and timely email correspondence
• Review waitlisted PTO for additional approvals within business parameters
• Perform system maintenance for employee new hires and terms
• Work Monday through Friday within 7:00 AM to 8:00 PM EST based on business needs, with at least a monthly weekend rotation or as required

Analyst – Resource Planning

Project Manager

• Direct all aspects of customer benefit plan implementation for self-funded new business clients
• Partner with internal and external stakeholders to identify and address critical implementation issues
• Act as the single point of contact for benefit plan implementation
• Mediate and coordinate resolution of project deliverables and implementation-related tasks
• Develop and execute implementation strategies consistent with customer expectations
• Ensure strategy is administered in accordance with performance guarantee arrangements
• Engage team members to follow through on responsibilities
• Evaluate the impact of customer-requested exceptions and develop alternatives that satisfy client needs while minimizing impact on systems and operations
• Solicit and assess internal and external customer feedback to enhance continuous quality improvement

Senior Analyst, Project Management

Pharmacist

• Support the pharmacy team in delivering operational and service excellence
• Serve as a first point of contact for patients and customers
• Follow SOPs and pharmacy workflow procedures across production, pick-up, drive-thru, and drop-off
• Ensure prescriptions are filled promptly, safely, and accurately
• Provide empathetic and personalized patient service and resolve or escalate patient problems
• Offer immunizations and other services at the register and over the phone where permitted
• Complete inventory activities including medication deliveries, cycle counts, returns-to-stocks, and waiting-bin inventories
• Collaborate with the pharmacy team and contribute to a safe, inclusive, high-performing team
• Travel voluntarily to other stores in the market for shifts as needed
• Comply with laws, regulations, professional standards, ethical principles, and CVS policies
• Deliver additional health care services such as immunizations, point-of-care testing, and offsite clinics where permitted and properly trained
• Support vaccine preparation and administration when authorized, including patient education, adverse-reaction monitoring, documentation, and vaccine-supply management
• Perform additional tasks as directed by a Supervisor or Manager

Pharmacy Technician

Psychologist

• Serve as the principal utilization management reviewer for Applied Behavior Analysis (ABA) cases
• Provide daily support and guidance to the ABA prior authorization clinical team and health plan medical directors
• Review cases related to psychological and neuropsychological testing
• Participate in clinical meetings with care management and utilization management teams
• Provide subject matter expertise on ABA-related questions and member concerns
• Contribute to medical management programs and policies addressing neurodevelopmental disorders
• Recommend enhancements to managed care review guidelines and clinical criteria
• Support Medicaid-wide initiatives benefiting members with neurodevelopmental disorders
• Support provider education initiatives for professionals specializing in neurodiversity
• Address quality assurance and fraud, waste, and abuse issues

Clinical Psychologist – BCBA-D

Operations

• Analyze complex transportation data, routes, and delivery patterns to identify cost reduction and operational efficiency opportunities
• Examine and optimize carrier selection, route planning, and load consolidation
• Analyze shipment volumes, transportation costs, transit times, carrier performance, and related metrics
• Perform freight payment and audit functions, ensuring contract compliance and freight rate matching
• Evaluate and manage relationships with carriers, freight forwarders, and third-party logistics providers
• Develop and monitor transportation KPIs and provide management with performance updates
• Identify and implement continuous improvement strategies
• Use transportation management systems and data analytics to improve supply chain visibility and track shipments in real time
• Collaborate with procurement, inventory management, and demand planning teams
• Lead transportation-related technology implementation and process improvement projects
• Interact with retail leaders and associates in Category Management, Inventory Management, Logistics, and Distribution Centers
• Provide ad-hoc analysis and reporting

Senior Transportation Operations Analyst

Financial Planning and Analysis

• Lead operational and financial performance evaluation across Aetna's Utilization Management programs
• Own business cases and value assessments for utilization management programs
• Build task-based staffing models and connect them with budgeting and forecasting for Aetna Clinical Solutions
• Lead executive performance reporting with holistic insights into program performance and ROI
• Establish program optimization frameworks to improve effectiveness and drive additional value
• Develop or collaborate on analytical tools and dashboards for outcome and savings insights
• Serve as the primary point of contact for performance management of Utilization Management programs
• Drive knowledge sharing and collaboration on performance management processes across functional areas

Manager, Finance Performance Management

Outreach Coordinator

• Serve as a subject matter expert in HEDIS improvement work
• Interact with providers and/or members to improve healthcare outcomes, including preventive care compliance
• Support provider engagement and participate actively in workgroups
• Deliver quality information to internal and external constituents through written and verbal communication
• Identify process improvement opportunities and create efficient work streams
• Independently map provider outreach work plans and execute deliverables
• Support complex relationships with internal and external constituents
• Consult on solutions to business issues, education, and process improvement opportunities
• Support provider partners with HEDIS gaps in care, digital solutions, remote medical record collection discussions, and education
• Collaborate with provider partners to enhance collaboration with Aetna
• Support HEDIS quality initiatives and regulatory/contractual requirements, including outreach to noncompliant members
• Support medical record capture for HEDIS medical record review and abstraction of supplemental data
• Participate in public speaking

HEDIS Outreach Coordinator

Advocate

• Make inbound and outbound calls to members and providers throughout the working day
• Help members obtain healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers affecting members’ health
• Deliver a professional and empathetic member experience
• Educate members to support healthy decisions
• Discuss benefits for specific screenings and medications
• Assist with health services, medications, and resources to improve Star health outcomes
• Accurately document conversations in members’ health records
• Escalate issues for resolution when needed
• Meet business metrics and goals

Health Advocate – Outbound Calls, Healthy Outcomes Team

• Support the pharmacy team in delivering operational and service excellence within the store
• Serve as an initial point of contact for patients and customers
• Follow company SOPs and pharmacy workflow procedures across production, pickup, drive-thru, and drop-off
• Help ensure prescriptions are filled promptly, safely, and accurately
• Provide empathetic and personalized patient service and resolve or escalate patient problems
• Offer immunizations and other services at the register and over the phone where permitted
• Complete inventory activities including putting away medication deliveries, cycle counts, returns-to-stocks, and waiting-bin inventories
• Expand clinical and technical knowledge and respond to feedback
• Remain flexible for scheduling and business needs, including voluntarily traveling to market stores for shifts
• Comply with applicable laws, regulations, professional standards, ethics, and CVS policies
• Deliver additional services such as immunizations, point-of-care testing, and offsite clinics where allowed and trained
• Where permissible, support immunizations by completing required training/licensure, educating patients, monitoring adverse reactions, documenting patient information, and managing vaccine supplies
• Perform additional tasks as directed by the Supervisor or Manager

• Support the build and maintenance of Epic Healthy Planet registries, health maintenance topics, care gap alerts, and best practice advisories tied to Star Ratings measures
• Translate HEDIS technical specifications and CMS Star Ratings measure criteria into Epic build requirements alongside senior analysts and architects
• Configure and test quality measure logic within Epic to ensure accurate gap identification and closure tracking
• Troubleshoot day-to-day issues related to Star measure workflows, registries, and reporting discrepancies
• Build and maintain reports using Reporting Workbench, Clarity/Caboodle, and SlicerDicer
• Validate quality measure data and resolve discrepancies between Epic data and quality reporting outputs
• Support monthly and quarterly Star Ratings reporting cycles and timely data delivery to Quality and Population Health teams
• Serve as a point of contact for clinical and quality staff regarding Star measure workflows and Epic documentation
• Partner with Quality, Population Health, and ACO teams to gather requirements and communicate build updates or limitations
• Participate in testing and validation sessions with end users before releasing new builds or measure updates
• Maintain documentation of build configurations, workflows, and measure logic
• Support change control processes for annual HEDIS/CMS specification changes
• Track and manage assigned work items in agile tools such as Rally

Senior Analyst

• Design enterprise-wide and/or cross-functional solutions supporting Medicaid value-based operational strategies
• Partner with business owners to optimize strategic business objectives, profitable growth, and organizational effectiveness
• Assist in managing day-to-day complex business consultation services
• Implement processes for researching, collecting, analyzing, and compiling data for business consulting reports
• Assess files, reports, and financial records and manage department record retention
• Direct individuals in delivering customer service, resolving inquiries, or redirecting issues
• Confer with clients and senior management regarding organizational goals and objectives
• Coach internal and external department points of contact on concise communication
• Prepare analyses and advise senior management, stakeholders, and clients on business trends and best practices
• Implement performance appraisal processes ensuring compliance and continuous improvement
• Help establish and implement strategic review processes supporting continuous improvement, compliance, and high-performance standards

Manager, Medicaid Value-Based Care Operations

Director

• Lead, coach, and develop technology controls assurance teams
• Manage priorities, resources, and workloads
• Build and retain high-performing teams
• Ensure consistency in testing methods, documentation, and quality standards
• Oversee testing of IT General Controls, IT Application Controls, and automated controls
• Support SOX technology risk assessments and annual scoping activities
• Evaluate control deficiencies and determine business and compliance impacts
• Partner with business and technology teams to address and remediate control issues
• Provide guidance on emerging technology risks and control requirements
• Serve as a primary liaison with external auditors
• Support reliance activities related to IT controls and SOC reports
• Coordinate with Internal Audit, Finance, Compliance, and Technology teams
• Oversee co-sourced audit resources and third-party providers
• Advise leaders on technology risks related to system implementations, cloud migrations, automation initiatives, platform modernization, and organizational changes
• Translate technical risk and control concepts into clear business recommendations
• Support executive reporting and Audit Committee communications
• Improve control testing through automation, data analytics, continuous monitoring, and AI-enabled testing techniques
• Stay current on evolving regulations, audit standards, cybersecurity risks, and emerging technologies

Lead Director, Internal Audit – Technology Controls Assurance

• Own the multi-site WMS implementation roadmap aligned with corporate objectives and timelines
• Chair central governance forums and establish decision-making frameworks, risk thresholds, and escalation paths
• Lead design, configuration, testing, training, change management, deployment, and post-go-live hypercare
• Set stage-gate entry and exit criteria and ensure deliverables, approvals, and readiness
• Own cutover and stage-gate decisions with executive sponsors, site leadership, and PMO
• Define and maintain design standards, operational principles, standardized processes, configurations, and SOPs
• Capture and disseminate lessons learned and reusable implementation assets
• Assess site readiness and lead remediation plans
• Direct mock runs, pilots, and phased deployments
• Establish hypercare teams, roles, SLAs, and escalation protocols
• Manage WMS health metrics, trend data, throughput, and quality metrics; implement corrective actions
• Transition sites to steady-state support with documented playbooks and ownership
• Manage program budgets, forecasts, variances, vendor statements of work, and change orders
• Lead, develop, and recruit central team resources
• Establish performance expectations, coach capability building, and support succession
• Educate DC leaders, drive WMS adoption, manage resistance, and develop communication plans
• Provide executive briefings and site-level huddles
• Integrate Operations, IT, Engineering, Training/Change, and Finance efforts
• Align program dependencies and resolve cross-team blockers
• Coordinate with vendors and partners on configuration, integrations, and issue resolution

Executive Director, Warehouse Management Systems

Outside Sales

• Manage sales growth by building a book of business through field sales marketing activity and in-home and community-based sales efforts
• Sell Medicare products
• Own the member relationship throughout the year after acquisition
• Serve as primary contact for member inquiries about plan benefits, products, and services
• Resolve member issues related to product utilization
• Prepare and analyze sales forecasts, results reports, presentations, and budget variance analyses
• Support sales revenue target setting and forecasting
• Research market demand
• Support sales teams in evaluating deal scenarios and contract terms
• Collaborate with sales, IT, and finance on reporting requirements and revenue forecasting systems
• Build and maintain client relationships
• Promote sales products and services and summarize progress and critical wins to management
• Analyze market trends to identify sales opportunities
• Develop and implement sales strategies and deliver presentations to stakeholders and management
• Facilitate team meetings and training sessions
• Provide product and service education and training
• Manage customer accounts and resolve issues promptly
• Collaborate with cross-functional teams to achieve sales goals and targets
• Communicate goals and deliverables to internal team members and senior leadership
• Meet acquisition, conversion, cross-sell, and retention targets
• Contact prospective members within required time limits
• Maintain high member satisfaction

Solution Architect – Epic STARS

Analyst – Resource Planning

Senior Analyst, Project Management

Pharmacy Technician

Clinical Psychologist – BCBA-D

Senior Transportation Operations Analyst

Manager, Finance Performance Management

HEDIS Outreach Coordinator

Health Advocate – Outbound Calls, Healthy Outcomes Team

Pharmacy Technician

Senior Analyst

Manager, Medicaid Value-Based Care Operations

Lead Director, Internal Audit – Technology Controls Assurance

Executive Director, Warehouse Management Systems

Field Sales Representative – South Florida