CVS Health

Full-stack Engineer

• Own and evolve member support services for Aetna Health web and mobile applications
• Design, develop, and implement software solutions and systems
• Apply advanced technical expertise to architect and code software applications
• Conduct system testing and debugging
• Collaborate with cross-functional teams
• Contribute to the technical direction and innovation of digital engineering projects

Senior Software Engineer

Case Coordinator

• Collaborate with members, providers, and community organizations to address healthcare and social determinant needs
• Facilitate appropriate healthcare outcomes by assisting with appointment scheduling and access to benefits and member education
• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
• Evaluate benefit plans and internal and external programs/services to recommend case-resolution approaches
• Identify high-risk factors and service needs, referring 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 through established channels
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs
• Use motivational interviewing to promote member engagement, lifestyle, and behavior changes
• Provide coaching, information, and support for independent medical and healthy lifestyle choices
• Help members participate knowledgeably in healthcare decisions with providers
• Apply case management and quality management processes in compliance with regulatory, accreditation, and company requirements
• Interact with members/clients telephonically or in person, including possible visits to homes, worksites, or physicians’ offices

Case Management Coordinator – Field

Pharmacist

• Support the pharmacy team in delivering operational and service excellence
• Assist patients and customers as a first point of contact
• Follow company SOPs and pharmacy workflow procedures across production, pick-up, drive-thru, and drop-off workstations
• Ensure prescriptions are filled promptly, safely, and accurately
• Provide empathetic and personalized patient service and resolve or escalate patient problems
• Offer immunizations and other health 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
• Expand clinical and technical knowledge to better assist patients
• Remain flexible for scheduling and business needs, including voluntarily traveling to market stores for shifts
• Comply with applicable laws, regulations, professional standards, ethical principles, and CVS policies
• Deliver additional services such as immunizations, point-of-care testing, and offsite clinic staffing where permitted and trained
• Where permissible, support vaccine preparation and administration, patient education, adverse-reaction monitoring, documentation, and vaccine-supply management
• Perform additional tasks as directed by the Supervisor or Manager

Pharmacy Technician

Analyst

• Complete comprehensive analyses of operational processes, workflows, and systems to identify improvement areas
• Analyze data and KPIs to identify trends, bottlenecks, and efficiency opportunities
• Develop and implement process improvement initiatives to streamline operations and increase productivity
• Identify and eliminate bottlenecks, redundancies, and non-value-added activities
• Analyze operational data to generate insights and support decision-making
• Configure reports, dashboards, and presentations to communicate operational performance and trends
• Communicate industry trends, emerging technologies, and operations best practices to stakeholders
• Drive a culture of continuous improvement and encourage team members to contribute ideas and solutions
• Identify areas of concern and recommend corrective actions

Senior Analyst

Risk

• Oversee privacy incident response, operations, and technology solutions protecting sensitive organizational data
• Conduct privacy incident investigations
• Help oversee privacy incident response
• Draft privacy policies and documentation related to privacy incidents, remediation, and investigations
• Collaborate with cross-functional teams to implement effective privacy programs
• Respond to data incidents and breaches
• Maintain compliance with privacy, security, and data governance standards
• Mentor and develop team members in privacy and compliance practices

Senior Manager, Information Governance and Privacy

• Build and maintain Epic environments
• Lead discovery calls and provide level-of-effort estimates
• Facilitate design sessions with business leaders and analysts
• Create and fulfill EHR use cases
• Identify business and functional requirements
• Translate requirements and workflows into technical specifications with IT resources
• Lead documentation efforts for discovery and implementation
• Ensure requirements and future-state workflows are clearly defined
• Work with project managers to identify tasks and associated estimates
• Support vendor upgrades, system changes, and environment maintenance procedures
• Collaborate with providers, project managers, technical resources, subject matter experts, business stakeholders, and vendor representatives
• Document business and functional requirements, system specifications, and testing attributes and results
• Analyze current-state processes and collaborate with clinical business and reporting users to create future-state processes
• Identify and document process and data gaps
• Create and complete use cases, business requirements, technical specifications, scope documents, gap analyses, and impact assessments

Senior Software Development Engineer

Medical writer

• Support all care teams across the region through comprehensive and targeted chart reviews
• Facilitate efficient and effective medical care for patients
• Partner with regional leaders, particularly the Population Health Director and Senior CIS, to support daily huddle and CDR workflow optimization
• Access and review HIE/EMRs to identify potential suspects based on test results
• Identify the need for Medical Records requests from Blue Button and other payer data
• Prepare and lead monthly Rejected Suspect Reviews
• Partner with the Population Health Director on general review support
• Identify and analyze opportunities to improve patient quality outcomes and cost of care
• Analyze chronic condition prevalence based on patient demographics and identify intervention opportunities
• Monitor clinical documentation efforts
• Perform other duties as assigned

Senior Specialist, Clinical Documentation

Actuary

• Develop underlying pricing factors and assumptions used in NA/PEX pricing
• Maintain pricing tools and assist with enhancements
• Conduct ad hoc pricing studies and requests from business partners
• Monitor emerging results
• Collaborate with Underwriting on plan sponsor pricing opportunities for new and renewal business
• Collaborate with other departments to assist with pricing assumptions
• Support pricing, forecasting, and financial management of fully insured business
• Analyze large-scale data and evaluate emerging trends
• Develop pricing assumptions and enhance analytical tools
• Support new and renewal business opportunities

Analyst, Actuarial

General

• Intake, investigate, and resolve appeals, complaints, and grievances for all products
• Coordinate responses from multiple business units for cases containing multiple issues
• Research incoming electronic work items and reroute items that do not meet applicable criteria
• Research plan design and certification of coverage to assess benefit or administrative denials
• Research claim processing logic, member eligibility data, and billing/payment status before initiating appeals
• Identify and research all components of member or provider/practitioner cases
• Triage incomplete case components to subject matter experts in other business units
• Coordinate final resolution communications to members or providers and close cases
• Serve as a technical resource to colleagues on appeals, complaints, and grievance issues
• Identify trends and emerging issues, report findings, and recommend potential solutions

Appeal and Grievance Coordinator

Investigator

• Conduct high-level, complex investigations of suspected healthcare fraud and abuse
• Investigate program-integrity matters involving aberrant Medicaid claims
• Research subjects and related entities
• Independently conduct proactive data mining using SIU tools
• Analyze claims data to identify aberrancy, patterns, and schemes
• Research and prepare cases for clinical and legal review
• Collaborate with Medical Directors on clinical issues and medical-record questions
• Document case activity and communications in the designated tracking system
• Communicate clinical findings to providers
• Adhere to regulatory requirements
• Facilitate recovery of company and customer funds lost through aberrant billing
• Train and guide new and junior investigators
• Assist junior investigators with resources and investigative strategy
• Serve as backup to the Team Leader as needed
• Collaborate with federal, state, and local law-enforcement agencies on healthcare-fraud investigations and prosecutions
• Present healthcare-fraud findings and FWA knowledge to internal and external stakeholders
• Testify in civil and criminal proceedings
• Develop professional presentations on healthcare fraud matters and enterprise FWA approaches
• Recommend efficiency gains and provide input on FWA monitoring controls

Senior Investigator, Special Investigations Unit – SIU

Nurse

• Act as a liaison with members/clients/families, employers, providers, insurance companies, and healthcare personnel
• Implement and 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 potentially meeting in homes, worksites, or physician’s offices
• Assess and analyze injured, acute, or chronically ill members’/clients’ medical and/or vocational status
• Develop plans of care to support condition management, wellness, medical outcomes, return to work, and benefit eligibility
• 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 rehabilitation-service laws, regulations, insurer instructions, and referral-source requirements
• Evaluate needs and benefit-plan eligibility using clinical tools and data
• Monitor progress toward desired outcomes through assessment and evaluation
• Develop proactive courses of action to improve short- and long-term outcomes and overall wellness

Case Manager, Registered Nurse

Project Manager

• Lead the design, planning, pilot, and delivery of automation and technology solutions from concept through implementation
• Partner with stakeholders, product owners, architects, and engineering teams to translate business needs into technical solutions, user stories, acceptance criteria, and delivery plans
• Manage and prioritize the product backlog
• Facilitate PI planning, sprint planning, backlog refinement, and other Agile ceremonies
• Drive collaboration across business, operations, clinical, and technology teams
• Align requirements, manage dependencies, and achieve business outcomes
• Develop and maintain business requirements, process flows, outcome measurements, dashboards, roadmaps, and governance documentation
• Monitor initiative progress, identify and mitigate risks, resolve issues, and provide status updates and executive-level reporting
• Evaluate and challenge solution designs, architecture decisions, and implementation approaches
• Communicate with engineers, architects, and technical stakeholders regarding APIs, integrations, rules engines, microservices, EDI, and enterprise technology platforms

Senior Manager – Project Program Management

Operations

• Conduct internal and external penetration tests to identify and exploit vulnerabilities
• Develop and execute adversary emulation scenarios
• Assess the effectiveness of detection and response capabilities
• Use and maintain penetration testing tools including Kali Linux, Metasploit, Nmap, and custom scripts
• Create detailed reports with findings and actionable remediation recommendations
• Design and execute purple team exercises with blue teams
• Provide insights to improve security monitoring, alerting, and incident response
• Facilitate knowledge-sharing sessions on adversary tactics, techniques, and procedures
• Contribute to adversary operations strategy aligned with organizational risk management goals
• Report security gaps, risks, and security-control effectiveness to executive leadership
• Prioritize remediation based on risk impact and operational feasibility
• Automate penetration testing tasks using Python, PowerShell, or Bash
• Contribute to custom red-team and penetration-testing tool development
• Support incident response investigations with adversary tactics insights
• Develop threat-hunting use cases and refine detection capabilities based on attack simulations

Senior Adversary Operations Engineer

Nurse Practitioner

• Deliver evidence‑based primary and family care, including assessment, diagnosis, treatment, and management of acute and chronic conditions
• Provide both in-person and virtual visits from the clinic to support positive patient health outcomes
• Perform diagnostic testing, preventive counseling, treatment of injuries and illnesses, and coordination of care with other healthcare professionals
• Engage patients in wellness services, chronic disease management, and preventive health screenings
• Complete essential clinic operations including inventory management, clinic opening/closing, patient follow‑up, insurance verification, and payment collection
• Support a safe and efficient care environment through routine examinations and timely patient appointment management

• Support the pharmacy team in delivering operational and service excellence within the store
• Assist patients and customers as a first point of contact and provide exceptional service
• Ensure pharmacy operations run smoothly and prescriptions are filled promptly, safely, and accurately
• Follow company SOPs and pharmacy workflow procedures across production, pick-up, drive-thru, and drop-off workstations
• Show empathy and genuine care while serving patients and resolving or escalating problems
• Complete basic inventory activities, including medication deliveries, cycle counts, returns-to-stocks, and waiting bin inventories
• Expand clinical and technical knowledge to better assist patients
• Remain flexible for scheduling and business needs and voluntarily travel to market stores for shifts as needed
• Comply with federal, state, and local 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 trained
• Complete additional licensure and training to obtain Technician Immunizer status where permissible
• Educate patients about vaccines and refer vaccination questions to the Pharmacist-on-duty
• Monitor and respond to adverse reactions and report events
• Review, collect, track, and document patient information
• Monitor and manage vaccine supplies
• Perform additional tasks as directed by a Supervisor or Manager