CVS Health

Associate

• Review and resolve pharmacy inquiries related to Non-MAC pricing, ensuring compliance with Non-MAC law requirements
• Validate pricing and product information using trusted sources such as Medispan and wholesaler information
• Identify changes in marketplace conditions and escalate potential issues to leadership
• Assist Non-MAC team contractors by answering questions and providing training support
• Monitor and perform testing activities related to IT system implementations as needed
• Research and respond to Department of Insurance inquiries with accurate and timely information for state regulators
• Assist management with ad hoc tasks and special projects

Business Analytics Associate

Full-stack Engineer

• Lead technical initiatives solving complex, enterprise-wide problems while ensuring maintainability, performance, and scalability
• Design, build, and maintain business-critical, enterprise-grade systems using modern technology and techniques
• Deliver incremental value through iterative, customer-focused releases
• Drive long-term improvements focused on simplicity and maintainability
• Collaborate across organizations to develop solutions meeting cross-organization needs
• Research, propose, and adopt leading-edge technology
• Continually refine yourself and others through learning and mentorship
• Architect and build highly distributed, large-scale systems powering clinician-facing experiences and clinician performance management
• Set technical direction across the team and raise the engineering bar through mentorship and cross-functional collaboration

Staff Software Engineer – Full Stack

Medical Director

• Lead utilization management, including predetermination and UM reviews
• Apply clinical expertise to support accurate, consistent decisions
• Participate in the development, implementation, and evaluation of clinical/medical programs
• Help expand Aetna's medical management programs across the continuum of care
• Support Medical Management staff in delivering timely, consistent responses to members and providers
• Oversee utilization review and quality assurance activities
• Direct case management efforts
• Provide clinical expertise and business direction for medical management programs through active participation in clinical team activities
• Serve as lead clinical and business liaison to network providers and facilities
• Represent Aetna One Advocate in external-facing presentations and plan sponsor meetings, approximately 15% of the time
• Provide clinical oversight for medical policy implementation

Medical Director – Aetna One Advocate

Accounts Receivable

• Contact customers by phone, email and/or written correspondence regarding past-due account balances
• Review account history, billing details, payment status and notes
• Explain balances, due dates, payment expectations and available resolution options
• Negotiate payment arrangements within approved guidelines
• Document collection activity, customer interactions, disputes and follow-up actions in appropriate systems
• Research account issues and work with internal teams to resolve billing discrepancies or payment concerns
• Monitor assigned accounts and follow up to drive resolution and reduce aging balances
• Escalate complex, sensitive or unresolved accounts according to established procedures
• Maintain compliance with company policies and applicable consumer collection regulations
• Support reporting needs, account reviews and process improvement efforts
• Meet individual and team productivity, quality and collection performance expectations
• Perform other duties as assigned

Accounts Receivable Collector – Business-to-Consumer

Advocate

• Make inbound and outbound calls to members and providers regarding healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers preventing members from achieving good health
• Deliver professional, empathetic member experiences
• Educate members to support informed health decisions and improved outcomes
• Accurately document conversations in members’ health records
• Explain benefits for specific screenings and medications
• Assist members with health services, medications, and resources to improve Star health outcomes
• Escalate issues for resolution when needed
• Meet business metrics and goals while working efficiently in a fast-paced environment

Health Advocate – Inbound/Outbound Calls

Operations

• Analyze data and recommend actions
• Utilize SQL, Excel, Google Sheets, and PowerBI to extract and summarize data
• Leverage reporting and analytics to answer business questions
• Make recommendations to key stakeholders and provide tools or data needed to support strategic operations
• Manage the end-to-end reporting portfolio
• Serve as a subject matter expert in membership and engagement reporting
• Lead the design, development, and maintenance of routine reporting for assigned subject areas
• Create metrics and reports to monitor success and identify opportunities for improvement across initiatives to improve appropriate financial membership
• Partner with Clinic Operations, Product, Finance, Managed Care Operations, Population Health, and Executive leadership to drive membership initiatives
• Translate open-ended requests into proposed actions
• Tailor reporting and communication methodologies for different partner needs
• Proactively navigate and communicate around changing or competing priorities
• Perform other duties as assigned

Senior Associate, Membership Strategy – Operations

Consultant

• Review clinical documentation and apply evidence-based criteria, policies, and clinical judgment to support coverage determinations
• Assess, coordinate, monitor, and evaluate healthcare services across the continuum of care
• Collaborate with providers and care teams to facilitate appropriate treatment plans and care coordination
• Identify opportunities to improve healthcare quality, effectiveness, and benefit utilization
• Connect members to programs and resources supporting positive health outcomes
• Serve as a clinical resource and consultant to internal and external stakeholders
• Work in a computer-based 24/7 utilization management operation
• Collaborate frequently with providers, members, and interdisciplinary teams

Utilization Management Nurse Consultant

• Drive the day-to-day direction of CVSHV's engagement strategy with CVS Health business teams
• Guide relationship coverage, staffing, engagement tracking, and follow-through
• Develop understanding of CVS Health strategic priorities, organizational dynamics, and key initiatives through internal stakeholder engagement
• Translate internal information into relevant insights for the broader team
• Support special projects for CVSHV and executive leaders, including investment committee and board-level materials
• Evolve and optimize the portfolio value creation model
• Identify recurring portfolio company needs and formalize repeatable programs, resources, and approaches
• Build and maintain relationships with internal stakeholders and connect portfolio companies with relevant CVS Health stakeholders
• Partner with senior CVSHV leaders on in-depth portfolio reviews
• Develop insights on portfolio performance, strategic value, and opportunities to create additional value
• Directly support portfolio growth for select companies through management relationships, strategic support, and financial analysis
• Lead market and thesis development projects supporting CVS Health strategic initiatives and CVSHV investment opportunity areas
• Synthesize market development insights, competitive dynamics, emerging trends, and investment landscape into deliverables for senior-level strategy and investment decisions
• Contribute to fund-of-funds investment diligence and program management as needed
• Organize meetings and events, coordinate logistics, and manage related communications
• Travel 10–15%

Associate, Market Development

• Lead the clinical team at the Oak Street Health center
• Provide primary care alongside provider colleagues at 80% clinical time
• Perform administrative and leadership work at 20% of time
• Collaborate with the Practice Manager and Outreach Manager/Director on organizational objectives
• Drive implementation of Oak Street Health strategic initiatives
• Implement regional priorities under regional leadership
• Cascade organizational information and escalate care team concerns and ideas
• Coordinate and lead onboarding of new providers
• Model excellent medical care and care-model implementation
• Support daily huddles, patient care planning, admission prevention, and clinical documentation workflows
• Ensure evidence-based care and preventative care delivery
• Teach and implement Oak Street clinical guidelines
• Educate and support providers in the value-based full-risk care model
• Assess root causes when center metrics are not reached
• Coach providers and care teams and foster growth
• Conduct performance reviews and help providers develop goal plans
• Celebrate successes and communicate improvement opportunities
• Achieve triad best practices and support a positive workplace culture
• Perform other duties as assigned

Center Medical Director

Health Coordinator

• Make inbound and outbound calls to members and providers
• Help members obtain healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers affecting members’ health
• Deliver professional and empathetic member conversations
• Educate members to support healthy decisions
• Explain benefits for specific screenings and medications
• Assist members and providers with health services, medications, and resources
• Accurately document conversations in members’ health records
• Escalate issues for resolution
• Meet business metrics and goals while working efficiently in a fast-paced environment

Health Advocate – Call Coordinator, Healthy Outcomes Team

• Make inbound and outbound calls to members and providers to help obtain healthcare visits, screenings, vaccinations, and medication refills
• Work through barriers that stand in the way of members’ good health
• Deliver the best member experience through professional, empathetic conversations
• Provide education to members to help them make good health decisions that improve their health
• Accurately document conversations in members’ health records
• Explain benefits for specific screenings and medications
• Assist members and providers with important health services, medications, and resources to improve Star health outcomes

Service Advocate

• Lead annual, quarterly, and monthly planning
• Maintain OKRs, KPIs, milestones, dependencies, action logs, risk registers, and executive status reporting
• Partner with Delivery and Product leaders to monitor initiative health, team capacity, resource allocation, workload, and cross-functional execution risks
• Manage budgets, forecasts, actual spend, software and cloud costs, funding requests, and cost-optimization opportunities with Finance and Procurement
• Coordinate workforce and team operations, including onboarding, offboarding, leadership meetings, business reviews, offsites, communications, and change activities
• Oversee SaaS assets, licenses, vendors, contracts, renewals, statements of work, invoices, and performance documentation
• Coordinate security access reviews, audit requests, disaster recovery plans and exercises, remediation tracking, technical learning programs, and operational process documentation
• Connect leaders and partners across delivery, strategy, finance, security, procurement, and vendors
• Translate priorities into clear plans, reporting, controls, and follow-through across Engineering, Product, and Delivery

Engineering Operations Manager

• Build next-generation digital health platforms and deliver use cases into products
• Create proof of concepts to address customer challenges
• Design and implement efficient, scalable solutions meeting business requirements and quality standards
• Contribute to solution design and architecture discussions with architects and senior engineers
• Provide input on technical feasibility, performance optimization and scalability
• Participate in code reviews and ensure adherence to coding standards, best practices and quality guidelines
• Coordinate with team members, business leaders and IT leaders to align delivery and support decision-making
• Adopt best practices, new technologies and tools to improve productivity, efficiency and code quality
• Participate in code reviews, tech talks and workshops
• Implement complex features, enhance existing functionality and deliver high-quality code
• Provide guidance and mentorship to junior developers
• Provide expert support for complex issues and root-cause analysis
• Identify digital ecosystem gaps and develop performance-enhancing solutions

Staff Software Development Engineer

Manager

• Act as a liaison with members, clients, families, employers, providers, insurance companies, and healthcare personnel
• Coordinate case management activities for catastrophic cases and chronically ill members/clients across the continuum of care
• Interact with members/clients telephonically or in person, including in homes, work sites, or physician offices
• Assess medical and/or vocational status and develop plans of care
• Facilitate condition management, wellness, medical outcomes, return to work, and optimal functioning
• Communicate with members/clients and stakeholders, including medical providers, attorneys, employers, and insurance carriers
• Prepare required case work documentation
• Consult with internal multidisciplinary teams
• Contact treating physicians or specialists regarding care and treatment
• Provide education and prevention information
• Apply applicable laws, regulations, insurance-carrier instructions, and company policies
• Testify as required to substantiate case work or reports
• Evaluate member/client needs and benefit plan eligibility using clinical tools and data
• Develop proactive courses of action and monitor progress toward desired outcomes

Case Manager, RN – Compact License

Physician

• Provide in-home health evaluations in members’ private residences
• Engage one-on-one with members and answer health questions
• Review medications and medical history
• Perform physical evaluations
• Conduct additional diagnostic and preventive services when ordered, including diabetic eye exams, spirometry, and bone density screening
• Travel locally and within licensed states as needed
• Conduct virtual visits as needed
• Provide Signify Health services, including Diagnostic & Preventive Services products
• Build trusted relationships and help improve health outcomes
• Connect members to appropriate care and identify gaps in care