CVS Health - Remote Work From Home Jobs & Careers | FlexJobs (2024)

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• 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.

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• KY

Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a members overall wellness. Uses clinical tools and information/data review to conduct evaluation...

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• Hartford, CT

Perform complex analytics and reporting on population health management, health and economic outcomes. Optimize risk scores, collaborate on risk adjustment programs, and provide process improvement recommendations.

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• VA

A Clinical Transformation Specialist is responsible for developing and implementing physical and behavioral health integration programs, providing education and technical support, and interfacing with providers to develop and implement Value Based Co..

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• Hartford, CT, Chicago, IL, Atlanta, GA, Blue Bell, PA, Overland Park, KS

Assess risk, analyze market data, develop new product offerings, collaborate with various teams, and oversee actuarial priorities to drive business growth and improve competitive position in the international market.

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• Phoenix, AZ, or US National

Formulate pricing strategy and execute financial modeling. Collaborate with sales and account services to provide recommendations on pricing and negotiation strategy. Develop and maintain domain expertise in PBM and enterprise profitability.

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• NY, NJ

Maximize revenue, retain and grow client relationships, and expand assigned book of business by negotiating and promoting Meritain Health products and services. Provide strategic leadership to service teams.

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• Harrisburg, PA

Supervise and evaluate staff, meet financial and operational objectives, build a strong team through training and mentoring, manage productivity and resources, resolve complex grievances, work rotational shifts.

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• KS

Negotiate, analyze, and manage contracts with providers across all lines of business. Recruit providers to expand the network. Collaborate cross-functionally on pricing and reimbursem*nt activities. Develop and refine network strategies.

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• Columbus, OH

Provide telephone-based consultation and counseling services to members, including crisis intervention, lifestyle management, and counseling sessions. Collaborate with a team of professionals and maintain compliance with policies and regulatory standards.

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• RI

Lead the execution of SOX projects, manage project scope, draft audit issues and reports, and oversee project team. Perform and document audit activities, interact with internal audit and business line management, and meet administrative reporting re..

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• Hartford, CT

Lead cloud engineering and automation teams to deliver innovative cloud-based solutions aligned with business goals. Develop cloud strategy, oversee cloud engineering management and automation, and foster team leadership and development.

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• Harrisburg, PA

Lead Solution Architect responsible for developing business, application/integration, data, infrastructure, platform, and security architectures. Collaborate with various teams to create solution architectures for key strategic initiatives and delive..

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• Hartford, CT

Lead a team of skilled engineers to design, develop, implement, and maintain integration solutions critical to the organization's infrastructure. Establish performance monitoring and optimization processes, ensure solutions comply with regulatory req..

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• RI

Manager specializing in strategic data analyses to support key business decisions for the PBM line of business. Use data-driven insights to develop winning business strategies and enhance existing solutions. Strong expertise in financial modeling, da..

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• Harrisburg, PA

Responsible for developing solution architectures for strategic initiatives. Collaborate with various teams to create architectures representing business, applications/integration, data, infrastructure, platform, and security.

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• NY

Lead a team of Analytic Consultants, manage analytic activities, develop relationships with sales teams, provide data-supported consultation, and stay updated on PBM plan management strategies and solutions.

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• Hartford, CT

Skilled Stability Engineer responsible for audit and vulnerability management, overseeing the Change Management process. Collaborate with cross-functional teams, generate reports, and drive action plans for audits and vulnerabilities.

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• CT

Architect, build, and support the Enterprise Data Platform for user data consumption tools. Manage and mentor team members, collaborate with cross-functional teams, and stay up-to-date with evolving cloud technologies.

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• Columbus, OH

Review and adjudicate routine Medicare claims, analyze and approve claims that cannot be auto adjudicated, manage claims on desk and queues, utilize system functions for accurate and timely claim processing.

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• Hartford, CT, Boston, MA, New York, NY

Lead Director responsible for talent strategy development, data-driven insights, collaboration with cross-functional teams, talent insight upskilling, continuous improvement, data analysis, metrics monitoring, reporting, and presentations.

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• MN

Build shared internal libraries, tools, and processes for teams to self-service build, test, deploy and operate systems. Develop scalable engineering solutions for cross-team concerns. Advocate for best practices in Android development.

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• LA

Assess and plan appropriate member physical and behavioral healthcare. Utilize clinical judgment to reduce risk factors and address complex clinical indicators. Develop and monitor established plans of care to meet member's goals.

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• Bloomington, MN, Downers Grove, IL

Lead discussions and negotiations for high-value rebate contracts with pharmaceutical manufacturers. Develop and foster strong relationships with direct manufacturers and industry partners. Coordinate with key leaders responsible for pharmacy benefit..

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• FL, TX

Bring your heart . 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...

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• Hartford, CT

Design, implement, and maintain automated workflows and processes for public cloud usage. Develop self-service automation frameworks and platforms. Integrate cloud automation solutions into CI/CD pipelines and software delivery processes. Stay up-to-..

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• 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.

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• Fresno, CA

Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response..

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• 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.

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• IL

Drive and support care management and care coordination activities. Utilize clinical judgment to facilitate member physical and behavioral healthcare. Coordinate psychosocial wrap-around services for optimal outcomes.

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• NJ, NY, OH, MI

Lead a team to prevent, investigate, and prosecute healthcare fraud and abuse. Provide direction and counsel on case handling. Develop relationships with law enforcement agencies and deliver training programs.

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• NJ

Lead cyber incident response team, manage, monitor, and correlate data, produce actionable information, analyze logs, forensic images, and threat models. Interface with business units, IT leads, and law enforcement. On-call rotation.

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• 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.

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• TX

Lead Director responsible for managing provider contracts, negotiating high-value contracts with complex providers, managing contract performance, identifying cost-saving initiatives, and collaborating cross-functionally to achieve network expansion ..

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• AL

Coordinate case management processes, evaluate member needs, implement care plans, and monitor progress. Collaborate with healthcare professionals to ensure quality care and empower members to make informed decisions.

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• AZ

Managing large, cross-organizational initiatives, ensuring on-time project delivery, leading virtual meetings, creating project plans, and resolving complex business issues through collaboration and problem-solving.

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• CT

Lead and oversee multiple complex projects and programs, manage tactical and strategic projects/initiatives, perform analysis and business requirements, and develop and implement a strategic project plan to achieve business goals.

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• US National

Responsible for providing telephone-based assessment, counseling, and informational services in a call center environment. Conducts risk, substance abuse, and mental health assessments, collaborates with a team of professionals, and maintains accurat..

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• PA

Oversee and lead a team responsible for managing incidents affecting systems, colleagues, members, and clients. Organize, prioritize, and manage multiple tasks with a high level of detail. Develop and maintain strong collaborative relationships with ..

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• AZ

Lead transformational initiatives, set price operations standards, maintain operational KPIs, coordinate solutions with internal partners, and ensure continual improvement in pricing operations for a Fortune 5 company in the healthcare industry.

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• FL

Process Organization Determination and drug benefit exception requests in a call center environment. Conduct outreach to patients and providers, research and correct issues, and ensure cases are properly closed. Requires customer service experience a..

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• FL

Handle customer inquiries via phone, internet, or written correspondence. Maintain performance metrics, work as a team, and provide differentiated service experience. Requires 2-3 years of call center and medical terminology/insurance experience. Hig..

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• GA

Providing advocate care to assist members with a clear path to care, claims understanding, and resolution. Educating members with online resources and creating an emotional connection to champion for their best health.

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• Lansing, MI

Handle basic and routine customer service inquiries and problems via telephone, internet or written correspondence. Create a differentiated service experience, demonstrate service discipline and handle service challenges. Provide solutions to constit..

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• US National

Develop strategic, compliant responses to RFPs/RFIs by collaborating with stakeholders, conducting research, and leveraging past proposals. Maintain expert understanding of Medicaid products and services. Support content management and drive innovation.

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• PA

Provide sales support to the Keystone Market team, handling broker inquiries, building relationships with the sales team, and presenting updates to Producer World. Must have health insurance experience and excellent customer service skills."

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• OH

Design and implement clinical health medical services, monitor claim inventory, manage staffing, facilitate staff meetings, collaborate with staff and departments to simplify processes. Requires 3-5 years of experience and advanced problem solving skills.

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• NC, AZ, IL, FL

Develop and manage a team for sales, account management, and business retention. Analyze competitive environment, collaborate with enterprise partners, and drive change for profitable growth. Lead the team in executing strategies to achieve target cl..

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• MO

Strategically partner with insurance brokers and consultants to optimize product positioning, develop sales strategies, and maintain client relationships. Ensure clients are informed of regulatory issues and lead presentations for new business opport..

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• TX, AZ, IL, RI

Create and maintain documentation including policies, procedures, work instructions, and job aids. Generate innovative content ideas, analyze and develop procedural documentation, and manage content lifecycle. Strong leadership skills and excellent i..