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

• OK

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

• 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.

• Phoenix, AZ

Support development and delivery of strategic vision for Vulnerability Management. Collaborate with IT to implement technologies, manage adherence to control standards and security policies, and optimize practices for risk reduction.

• 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.

• 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..

• 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.

• 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.

• 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.

• Linthicum, MD

Answering inbound calls from Aetna Medicaid members and providers, providing assistance with inquiries regarding benefits, eligibility, services, and ID cards. Requires high-speed internet connectivity with secure service via ethernet cable. Company ..

• US National

Utilize clinical judgment and critical thinking skills to facilitate member physical and behavioral healthcare. Conduct telephonic case management, complete assessments, collaborate with partners, and assist members in locating community resources.

• 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.

• 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 ..

• US National

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

• 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..

• Frankfort, KY

Perform intake of calls from members or providers regarding services, screen requests for appropriate referral to medical services staff, approve services that do not require a medical review, and maintain accurate and complete documentation of requi..

• 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..

• NY, OH, IL, FL, CT, PA, RI

Manage PBM contract needs, collaborate with stakeholders, lead cross-functional work groups, develop/implement contract language, provide consultative support. Minimum 3 years' contract experience and PBM knowledge required. Bachelor's degree preferred.

• Hartford, CT

Lead a team of compliance professionals, implement and maintain an effective compliance program, manage regulatory interactions, analyze laws and regulations, build relationships with stakeholders, advise leadership on emerging risks.

• NY, AZ, TX, IL, FL

Monitor regulatory developments and their impact on PBMs and self-funded health plans. Coordinate cross-functionally to ensure operational success. Assess compliance risk areas and strategize with the Director of Compliance to identify vulnerabilitie...

• 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.

• 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.

• 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 (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.

• Woonsocket, RI, Scottsdale, AZ, Buffalo Grove, IL

Responsible for techno-functional impact analysis, design, and code construction activities for software development. Manage and support engineers, prioritize tasks, and collaborate with stakeholders to deliver high-quality projects on time and withi..

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

Lead a team of engineers to ensure the observability, reliability, scalability, and performance of systems. Work with cross-functional teams to build observability solutions, maintain and optimize systems, and align with business goals.

• GA

Develop technology solutions for Minute Clinic projects, including building backend services, web applications, and services. Participate in all stages of the project life cycle, provide technical expertise, and work with the team to achieve strategi..

• MI, OH, IL, IN, KY

Manage contractual obligations, reporting, workflows, and relationships with internal/external constituents. Travel up to 25% nationally. Requires knowledge of Medicaid programs and managed care industry practices. Bachelor's degree desired. Salary r..

• 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.

• US National

Responsible for the development, maintenance, and delivery of iOS applications. Collaborate with cross-functional teams to deliver great user experiences and ensure app performance. Interact and collaborate with IT teams and external vendors.

• Woonsocket, RI, Scottsdale, AZ, Hartford, CT

Lead the IT technology strategy for Pharmacy domain products, including AI initiatives. Provide technical vision, solve complex problems, and execute across Cloud, backend solution, AIML. Act as executive technical leader and partner with technical l..

• US National (Not hiring in HI, AK)

Provide worklife consultation and informational services to members and plan sponsors. Assess resource needs, propose options and research/screen potential community service providers. Complete outbound phone calls and research.

• TX, FL, PA, IL, NC, NJ, OH, NY, GA

Provide subject matter expertise, consultations, education, and case reviews to clinical staff and members. Collaborate with healthcare team to align nutritional interventions with care goals. Evaluate plan of care and effectiveness/outcomes of dieta..

• 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, MA

Monitor internal control systems to ensure information security, establish metrics for critical infrastructure components, provide security engineering training, respond to audits, and stay updated on information security technologies.

• Hartford, CT

Define product vision, strategy, and roadmap for HR service delivery within ServiceNow platform. Gather requirements from stakeholders, prioritize features based on business value and urgency, lead sprint planning and manage backlog.

• 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..

• 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.

• Hartford, CT

Design, develop, and implement HR service delivery solutions in ServiceNow. Customize and configure HRSD workflows, forms, fields, and business rules. Collaborate with stakeholders to gather requirements and translate user needs into technical solutions.

• 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 ..

• IL

Perform intake of calls from members or providers regarding services via telephone, fax, EDI. Screen requests for appropriate referral to medical services staff. Approve services that do not require a medical review in accordance with the benefit plan.

• 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..

• 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

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.

• Buffalo Grove, IL

Design, develop, and implement procurement solutions within the ServiceNow platform. Collaborate with procurement stakeholders and technical teams to optimize procurement operations and workflows. Troubleshoot and provide ongoing support for the Serv..

• Springfield, IL

Lead the design, development, and implementation of procurement solutions within the ServiceNow platform. Collaborate with procurement stakeholders to gather requirements and customize workflows and forms. Provide technical leadership and mentor juni..

• US National

Utilize clinical documentation skills to improve the quality and completeness of clinical documentation. Conduct chart reviews, audits, and coding validation to ensure accurate coding and risk score capture. Educate providers on documentation improve..

• Hartford, CT, Cary, NC, Northbrook, IL, Atlanta, GA, Scottsdale, AZ, Woonsocket, RI, Concord, CA, Irving, TX, Blue Bell, PA

Provide consultative support and analysis of markets and network initiatives. Prepare presentations, manage projects, and collaborate with local market leaders to improve patient care. Analyze medical costs, turn data into usable information, and ide..