CVS Health

Software Engineer

• Design and develop integration solutions between Workday and external systems such as payroll, benefits, HR, finance, and third-party applications
• Write code, develop software components, and implement complex functionalities according to project requirements
• Develop and configure Workday Extend applications
• Design modular Workday Orchestrate orchestrations, link external REST and SOAP APIs, process WQL and RaaS data, and manage error handling and conditional logic
• Develop complex Workday Studio integrations, including web services, transformation logic, and data mappings
• Leverage Workday Cloud Connect and other pre-built connectors
• Customize integrations according to business requirements and Workday best practices
• Build integration workflows that enable data synchronization and automation
• Integrate and deploy software components and systems
• Oversee production deployment of integration solutions
• Assist with data migration to Workday and external systems
• Update integrations for Workday quarterly releases and new functionality
• Participate in Agile or other development methodologies, meetings, and project planning
• Collaborate with development, functional, business analyst, and stakeholder teams on architecture, scalability, performance, and maintainability
• Gather requirements, provide updates, and resolve integration issues
• Coordinate with external vendors and service providers
• Support and monitor integrations, manage inbound and outbound issues, and lead incident resolution
• Assess Workday releases and plan necessary integration updates
• Create and maintain technical documentation, system designs, architecture diagrams, and code documentation
• Guide and mentor developers, analysts, and technical staff
• Foster cross-team collaboration and alignment with organizational objectives
• Troubleshoot complex technical issues and develop effective solutions
• Manage multiple projects and coordinate with stakeholders

Senior Workday Integration Developer – Extend, Orchestrate

Consultant

• Review and resolve clinical appeals
• Review documentation and interpret data from clinical records
• Apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements
• Independently coordinate clinical resolution with internal and external clinician support
• Support UM, MPO, Coding, or Behavioral Health appeals
• Work Monday–Friday, 8:00 AM to 5:00 PM local time
• Provide occasional weekend and holiday on-call coverage as required

Appeals Nurse Consultant

• Review and resolve clinical appeals
• Review documentation and interpret data from clinical records
• Apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements
• Address member and provider issues
• Coordinate clinical resolution independently with internal and external clinician support as required
• Support UM, including expedited appeals, MPO, Coding, or Behavioral Health appeals
• Work full-time in a telework arrangement

Analyst

• Facilitate appropriate healthcare outcomes for waiver/LTSS members through care coordination, support, and education
• Conduct comprehensive evaluations of referred members’ needs and eligibility
• Recommend case-resolution approaches by evaluating benefit plans and internal and external programs/services
• Identify high-risk factors and service needs affecting member outcomes and care planning
• Refer members to clinical case management or crisis intervention when 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’ benefit and healthcare needs
• Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavior changes
• Provide coaching, information, and support for independent medical and healthy-lifestyle choices
• Help members participate knowledgeably in healthcare decision-making with providers
• Apply case-management and quality-management processes in compliance with regulatory, accreditation, and company requirements
• Travel 50–75% and conduct in-person quarterly member visits

Analyst, Case Management

Counselor

• Provide telephone-based assessment, triage, consultation, counseling, and informational services in a call center environment
• Provide immediate 24/7 mental health support through video, live chat, or phone
• Use advanced clinical assessments, motivational interviewing, and solution-focused/short-term problem resolution
• Conduct risk, substance abuse, and mental health assessments
• Develop immediate action and safety plans based on urgency
• Recommend appropriate levels of mental health and substance-use care
• Understand members’ needs and align with their theory of change
• Provide information about mental health, substance abuse, community treatment, and related programs
• Coordinate resources and support linkage to care and lifestyle-management services
• Collaborate with professionals to support positive clinical outcomes and continuity of care
• Multitask by typing and documenting while handling calls and using supporting tools
• Protect member confidentiality and follow enterprise and EAP confidentiality policies
• Maintain accurate documentation meeting risk-management and regulatory requirements
• Maintain current independent behavioral health licensure and meet state licensure requirements
• Participate in periodic shift bidding; schedules may change based on business needs

Clinical Counselor – Employee Assistance Program

Manager

• Lead the analytical strategy, market intelligence, and decision support framework for complex deal evaluation, PBM negotiation strategy, and pharmacy reimbursement performance
• Serve as a strategic partner across the organization
• Translate business priorities, market dynamics, and analytical findings into actionable recommendations
• Own financial models and pre-negotiation intelligence packages for pharmacy benefit managers, health plans, third party discount providers, and state Medicaid plans
• Build multi-year deal strategies reflecting counterparty economics
• Produce scenario analysis establishing where CVS can trade and where it must hold
• Provide work product for live negotiations and recurring cross-functional forums, including the weekly Finance Call and Payer Operating Strategy meeting
• Support quantified negotiation positions and defined walk-away points

Senior Manager, Payer Deal Intelligence, Analytics Insights

Data Scientist

• Design, develop, deploy, and monitor machine learning models, predictive analytics solutions, and generative AI applications
• Build and maintain scalable data pipelines, data products, and curated datasets on Databricks
• Transform application, operational, and telemetry data into trusted enterprise assets
• Architect and deliver self-service analytics, interactive reporting, and conversational "chat with your data" experiences
• Write and review production-quality Python, SQL, and Spark code
• Establish best practices for software engineering, data quality, testing, model development, AI governance, and MLOps
• Own the team's technical roadmap and drive architecture decisions
• Partner with product managers, business stakeholders, engineers, architects, and technology leaders
• Prioritize opportunities, align technical solutions to business needs, and deliver measurable value
• Lead, mentor, and develop a high-performing team of data scientists, engineers, and analysts

Principal Data Scientist

• Build and maintain payer-specific playbooks covering CVS Pharmacy’s largest payer relationships
• Establish pre-positioning frameworks ahead of material negotiations
• Facilitate structured deal reviews and debriefs
• Drive adoption of approved negotiation preparation tooling across the function
• Translate market intelligence, stakeholder insight, and negotiation learnings into repeatable strategy
• Monitor shifts in PBM and health plan strategy
• Develop understanding of negotiation counterpart objectives
• Create practical playbooks and tools to improve negotiation consistency, precision, and confidence
• Lead post-mortem reviews of negotiation outcomes
• Refine strategy and strengthen playbooks using lessons learned
• Work regularly with Directors, Lead Directors, and above
• Support development toward deal ownership within Payer Relations

Senior Manager, Payer Negotiation Strategy, Market Intelligence

Claim Specialist

• Handle and process benefits claims submitted by healthcare providers
• Determine benefit eligibility and coverage based on insurance plans and policy guidelines
• Assess claims for accuracy, coding compliance, medical necessity, and documentation requirements
• Document claim information, codes, modifiers, and other data in company systems
• Review and investigate claims requiring additional scrutiny or validation
• Communicate with healthcare providers, patients, and stakeholders to resolve discrepancies
• Ensure claims processing complies with regulatory requirements, industry standards, and company policies
• Review and adjudicate routine claims according to processing guidelines
• Analyze and approve routine claims that cannot be auto-adjudicated
• Apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost-containment measures
• Coordinate responses to routine phone inquiries and written correspondence
• Route and triage complex claims to the Senior Claim Benefits Specialist
• Proof claim or referral submissions and apply appropriate guidelines, coding, member identification, diagnosis, and pre-coding requirements
• Facilitate training when serving as a subject matter expert
• Manage claims, queues, and ECHS within specified turnaround-time parameters
• Use applicable system functions, including claim check, reasonable and customary data, and post-containment tools
• Develop and implement feedback and performance review processes
• Analyze claims data and generate reports to identify trends and improvement opportunities

Claim Benefit Specialist

Pharmacist

• Coordinate pharmaceutical services within long-term care facilities with facility leaders and staff
• Guide development and evaluation of pharmaceutical services procedures
• Identify, evaluate, and resolve pharmacy-related concerns affecting resident care, quality of life, and regulatory compliance
• Ensure facilities remain compliant with federal regulations
• Complete clinical reviews required by federal and state regulations
• Own issue resolution and communicate early warning signs of potential issues
• Drive adoption of Omnicare programs and service offerings
• Promote organic growth and new business using existing customer relationships
• Conduct Executive Reviews and customer meetings
• Collaborate with Account Management, Sales, Operations, and corporate functions
• Perform Medication Regimen Reviews and provide written reports
• Use OSC2OR software to generate MRRs, therapeutic interchange, clinical recommendations, and response documentation
• Use the Minimum Data Set (MDS 3.0) health assessment tool to identify residents needing targeted focus
• Complete and transmit required quality improvement and consultant service reports
• Educate facility staff, including Directors of Nursing, Medical Directors, and Administrators, on new programs
• Work on-site in various client facilities within long-term care

Pharmacist Consultant – Long Term Care

Data Engineer

• Design, build, and maintain large-scale data infrastructure and data processing systems
• Implement robust and scalable solutions supporting data-driven applications, analytics, and business intelligence
• Integrate data from databases, APIs, and streaming platforms
• Optimize data processing and query performance through data pipeline, database configuration, and data partitioning improvements
• Establish data quality checks and validations and resolve data issues
• Implement data security measures including encryption, access controls, and regulatory compliance
• Collaborate with data scientists, analysts, software engineers, and business stakeholders
• Design and develop data warehouses, data lakes, and data pipelines
• Establish auditing and monitoring mechanisms for data access and governance
• Monitor and alert on bottlenecks, latency, and failures; troubleshoot problems, investigate root causes, and implement remediation
• Explore frameworks, platforms, and cloud services that improve data processing capabilities
• Leverage DevSecOps practices

Senior Data Engineer

Artificial Intelligence

• Act as a forward-deployed analyst partnering with Finance business units on AI adoption
• Observe workflows, identify opportunities, and support leaders in modeling responsible AI use
• Partner with training and communications teams to develop role-based AI enablement curricula
• Deliver training sessions, demonstrations, workshops, embedded coaching, hackathons, and lunch-and-learns
• Build and maintain prompt libraries, agent examples, use-case patterns, and plain-language guides
• Establish a practitioner community and champion network
• Surface literacy gaps, adoption barriers, and emerging misuse to the Lead Director and advisory councils
• Support user surveys and translate results into user journey maps and enablement strategies
• Measure adoption and learning effectiveness, establish baselines, and report capability gaps
• Convert recurring coaching into reusable assets
• Coordinate with governance, product, and business stakeholders
• Maintain operating cadence and align training to organizational standards
• Serve as the primary contact for hands-on support with desktop business AI tools such as Copilot and Claude Enterprise

Manager, AI User Enablement

Nurse

• Conduct comprehensive telephonic and face-to-face assessments of members’ medical, behavioral, and social needs
• Develop and implement personalized short- and long-term care plans
• Coordinate care across providers, programs, and services
• Use clinical expertise and data insights to identify risks, gaps in care, and intervention opportunities
• Support members with complex or multiple conditions using a holistic, whole-person approach
• Facilitate referrals to clinical and community resources
• Participate in case conferences and collaborate with multidisciplinary teams
• Review claims history and benefit eligibility to inform care planning
• Engage members through interviewing to build trust and encourage participation in their care
• Ensure case management activities comply with regulatory and organizational guidelines
• Blend in-person field visits with telephonic outreach to deliver coordinated, patient-centered care

Case Manager, Registered Nurse – Field

Business Analyst

• Provide comprehensive care management services to members enrolled in the New York Managed Long Term Care (MLTC) Plan
• Conduct psychosocial assessments and identify member needs
• Develop and implement person-centered service plans
• Coordinate long-term services and supports
• Facilitate access to medical, behavioral health, and community resources
• Collaborate with members, caregivers, providers, and interdisciplinary teams
• Promote member independence and improve health outcomes
• Address social determinants of health
• Ensure delivery of quality, cost-effective care
• Conduct member visits within the assigned service area as needed

Case Management Analyst

Account Executive

• Drive new business growth and expand CVS Pharmacy’s position within payer networks
• Develop and advance relationships with pharmacy benefit managers, health plans, discount program providers, and state Medicaid organizations
• Secure new agreements and strengthen strategic partnerships
• Identify, qualify, and advance new business opportunities
• Build and maintain an opportunity pipeline, forecast potential business impact, and track progress toward goals
• Develop and present business cases and proposals aligned with service, quality, network design, and volume commitments
• Partner with internal stakeholders to evaluate market opportunities and competitive positioning
• Support contract negotiations
• Facilitate transitions of newly executed agreements to account management teams
• Support performance reviews during the initial contract lifecycle
• Travel up to 20%

Senior Workday Integration Developer – Extend, Orchestrate

Appeals Nurse Consultant

Appeals Nurse Consultant

Analyst, Case Management

Clinical Counselor – Employee Assistance Program

Senior Manager, Payer Deal Intelligence, Analytics Insights

Principal Data Scientist

Senior Manager, Payer Negotiation Strategy, Market Intelligence

Claim Benefit Specialist

Pharmacist Consultant – Long Term Care

Senior Data Engineer

Manager, AI User Enablement

Case Manager, Registered Nurse – Field

Case Management Analyst

Payer Relations Account Executive