CVS Health Jobs & Careers - Remote Work From Home & Flexible

• US National

Bring your heart to . Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

• AZ

Build strong relationships with key client stakeholders, increase adoption of enterprise solutions, partner in new sales activities and product ideation, and provide leadership on strategic initiatives.

• OK, Oklahoma City, OK

Manage and oversee compliance with provider engagement responsibilities, manage local team to deploy national engagement model, co-facilitate provider advisory group and JOC meetings to implement changes via coordination Quality Management.

• MO

Play an integral role in educating patients with medication adherence and disease state training. As a national leader in the healthcare industry and a Fortune 7 company, we seek special RNs who not only possess strong...

• Chandler, AZ

Verification Representative, you are a critical liaison between our patients, healthcare professionals and insurance carriers. You will utilize your skills and healthcare industry expertise to efficiently solve insurance-related issues...

• LA

Implement clinical policies and procedures, mentor team members, ensure best practices are followed, manage resources, evaluate data and improve outcomes, recruit and hire staff, create a positive work environment, communicate effectively with stakeh..

• OK

Demonstrated experience with clinical program components, formulary designs, and prescription benefit trends. Experience working in a high production team environment.

• NJ

This Medical Director role requires an active state medical license and board certification in a recognized specialty. The responsibilities include ensuring timely and consistent responses to members and providers, supporting medical management staff..

• FL

Assess, plan, implement, and coordinate case management activities for members. Develop proactive care plans, conduct assessments, and utilize clinical tools to address health needs. Collaborate with interdisciplinary team members and ensure complian..

• KS

Physician needed to oversee healthcare services for individuals with disabilities, ensuring person-centered care, participating in quality improvement activities, and representing the health plan in fair hearings.

• VA

Ensure timely and consistent responses to members and providers regarding precertification, concurrent review, and appeal requests. Support the medical management staff as part of a centralized team. Have experience in healthcare delivery..

• Woonsocket, RI, Hartford, CT, Scottsdale, AZ, Chicago, IL, Dallas, TX

Provide advice and guidance on company policies, manage grievances and workplace inquiries, assist with coaching, corrective actions, terminations, and serve as a labor relations expert for business unit leaders.

• RI, TX, IL, MA, FL, CT, CA

Develop and improve processes for inventory control, data management, asset protection policies, and programs. Lead the COE's IQC organization in core production, audits, cycle count compliance, investigation & security. Standardize policies and proc..

• ME, NH, MA, RI, CT, NY, NJ, DE, MD, VA, NC, SC, GA, FL

Ensure observability, reliability, scalability, and performance of systems. Collaborate with cross-functional teams to build observability solutions. Optimize systems and align with business goals. Strong technical expertise and effective communicati..

• RI, NY, TX, IL, MA, CT, FL, CA

Implement regional strategy, manage IQC teams, collaborate with process improvement team, standardize policies and procedures, ensure inventory accuracy and compliance, manage asset protection and security activities.

• ND, SD, NE, KS, OK, TX, MN, IA, MO, AR, LA, WI, IL, KY, MS, AL, MI, IN, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT

Design, implement, and maintain ServiceNow Discovery solutions. Configure and optimize ServiceNow Discovery to identify assets and configuration items. Collaborate with cross-functional teams for integration and continuous improvement initiatives.

• RI, TX, NY, MA, FL, CT, CA

Manage inventory control, data management, asset protection policies and programs for a region of the distribution network. Collaborate with leadership, standardize processes and procedures to maximize operational efficiencies, ensure internal audit ..

• US National

Clinical Case Manager Behavioral Health: Utilize clinical judgment and critical thinking to facilitate member physical and behavioral healthcare. Conduct telephonic case management, complete assessments, collaborate with partners, and assist members ..

• IA, AZ, IL, KS, FL, IN, KY

Negotiate, execute, and conduct high-level review and analysis of contracts. Recruit providers to attain network expansion and adequacy targets. Collaborate cross-functionally to manage provider compensation and pricing development activities.

• IN

Negotiate, execute, review, and analyze contracts. Manage contract performance and contribute to provider compensation and pricing development activities. Recruit providers to ensure network expansion and adequacy targets are met.

• CT

Analyze and manage supplier data to optimize technology purchases. Collaborate with stakeholders to develop purchasing strategies and support long-term roadmaps. Present data insights and recommendations to drive cost savings and supplier performance.

• Honolulu, HI

As a Registered Nurse on the Health Management team, you will optimize members' wellness and independence, conduct telephonic health assessments, develop relationships with members, and coordinate quality, cost-effective care with healthcare teams.

• KY, WV

Manage and oversee compliance with Medicaid contractual requirements, develop innovative value-based solutions, negotiate high value contracts, recruit providers, evaluate and implement provider network strategic plans, and collaborate with internal ..

• USA, or US National

Utilization Management Clinician - Behavioral Health. Coordinate, document, and communicate all aspects of utilization/benefit management program. Assess treatment plans, coordinate with providers, and promote quality healthcare services.

• AZ, ID, UT, MT, WY, CO, NM, WA, OR, CA, NV

Utilization Management Clinician assesses treatment plans, coordinates healthcare services, provides crisis support, and promotes quality healthcare services. Requires clinical experience, crisis intervention experience, and experience with Autism Di..

• WA, OR, CA, NV

Answer inquiries from Medicare Advantage members via inbound calls, internet inquiries, and written correspondence. Provide exceptional customer service, resolve complex issues, and collaborate with team members to create a remarkable memb..

• FL

Provide exceptional customer service to Medicare Advantage members through inbound calls, internet inquiries, and written correspondence. Collaborate with team members, resolve complex issues, and navigate multiple systems...

• WA, OR, CA, NV

Answer customer inquiries about Medicare Advantage via calls, internet, and written correspondence. Provide personalized service, navigate systems, and resolve complex issues. Prioritize exceptional customer service and adaptability.

• US National (Not hiring in HI, AK)

Utilizes advanced clinical judgment and critical thinking skills to assess member needs, coordinate care, and promote optimal outcomes. Applies clinical strategies, consults with supervisors, and monitors care plans to ensure quality and effectiveness.

• US National

May perform or assist with integration and system testing, according to detailed test plans to ensure high-quality systems. May assist business partners with User Acceptance Testing.

• Hartford, CT, Scottsdale, AZ, Woonsocket, RI, Northbrook, IL, Richardson, TX

Designing and supporting complex contact center solutions and call routing that incorporate technologies such as Cisco Voice and Contact Center, Avaya Voice and Contact Center, Oracle SBCs, IVRs, and Five9 Contact Center as a Service.

• US National

Telephone-based assessment, triage, consultation, counseling and informational services. Conduct risk, substance abuse and mental health assessments to develop immediate action/safety plans. Collaborate with team for positive clinical outcome and con..

• US National

Design and support complex voice and contact center solutions, engineering multi-vendor solutions, staying current with technology trends, and collaborating with enterprise technology functions to maximize alignment, efficiency, cost optimization, an..

• Torrance, CA, Los Angeles, CA

Educate patients and caregivers on complex Pulmonary Arterial Hypertension therapies, coordinate patient care with physicians and sales team, travel within state 20-30% of the time, and maintain positive business relationships with medical personnel.

• US National

Effectively communicate prioritized strategies, progress towards expected financial outcomes, and provide meaningful insights regarding shrink results at the Executive level

• US National

Design, develop, and maintain automated solutions for Mainframe Db2 software. Collaborate with software development teams for process improvement and automation. Troubleshoot and resolve database-related issues.

• Hartford, CT

Collaborate with cross-functional teams to define and document hardware patterns and standards for open source/open systems hardware.

• Providence, RI

Facilitate collaboration with the 340B team to resolve issues related to over-replenished inventory. Ability to organize and manage multiple priorities including demonstrable experience in workflow management systems and/or service delivery.

• US National

Perform pharmacy review and make evidence-based recommendations for Medicare members. Identify opportunities for integration of quality measures in clinical programs. Provide clinical pharmacy support to Medicare membership.

• San Antonio, TX

Analyze and approve routine claims, apply medical necessity guidelines, verify eligibility, identify discrepancies, and apply cost containment measures. Route complex claims to Senior Claim Benefits Specialist.

• Toledo, OH

Coordinate events and meetings with community organizations to create brand awareness for Medicare Advantage Plans. Build relationships with Centers of Influence (COIs) to make the company the trusted name in Medicare Advantage in Ohio.

• US National

Develop personalized case management programs and refer to alternative healthcare. Conduct clinical assessments and advocate for patients. Use assessment techniques and motivational interviewing to promote lifestyle changes for optimum health.

• MD, DE, PA, VA

Perform remote pharmacy diversion investigations using advanced tools and data analysis. Serve as the primary point of contact for diversion concerns and collaborate with cross-functional partners to resolve cases.

• CT, DE, ME, MA, MD, NH, NJ, NY, PA, RI, VT

Remotely investigate internal pharmacy drug diversion cases by analyzing data, performing investigations, and acting as the primary point of contact for pharmacy concerns. Collaborate with cross-functional partners and provide updates in a confidenti..

• US National

Collaborate with care management team to support members on their path to better health, provide comprehensive medication reviews and education, interpret formulary, and develop working relationships with care management team and internal departments.

• AZ

Responsible for outbound calls to members/providers for verification, processing and adjudicating paper claims, and maintaining integrity of claims receipts. Meeting productivity and accuracy standards within turnaround times.

• FL

Nurse Care Manager is responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness.

• US National (Not hiring in HI, AK)

Design and implement test automation solutions for product development. Collaborate with product team to refine user stories and support testing strategies. 10+ years of quality engineering experience in a product-centric ecosystem required.

• LA

Support comprehensive coordination of medical services including intake, screening, and referrals. Utilize Aetna system to build and enter member information. Maintain accurate documentation and promote communication with various stakeholders.

• US National (Not hiring in HI)

Facilitates member healthcare through assessment, care planning, provider coordination, and psychosocial services. Reduces risk factors, consults with supervisors, and monitors care quality through case management and quality processes.