The Regulatory Filing Specialist manages PBM licensing and regulatory reporting activities while ensuring compliance with state requirements. They also conduct regulatory research, support audits, and collaborate with cross-functional teams to provide compliance guidance.
The Case Manager RN performs comprehensive clinical assessments and develops individualized care plans to promote optimal, cost-effective health outcomes. They provide ongoing coaching, education, and advocacy to empower members to make informed medical and lifestyle choices.
Design, build, and operationalize scalable Generative AI solutions within a HIPAA-regulated healthcare environment. Collaborate with cross-functional teams to implement machine learning models and lead technical strategy for AI systems.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Engage with patients to answer health questions and provide connections to appropriate care services based on their unique needs.
Conduct approximately 30-minute video visits with health plan members to perform medication and medical history reviews. Provide education to members regarding their health needs and ensure high-quality care delivery while meeting operational and clinical performance metrics.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct pre-scheduled in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide health education and ensure accurate documentation of diagnostic and preventive services.
Conduct in-home health evaluations to review medical history, perform physical assessments, and bridge gaps in patient care. Provide virtual visits as needed and coordinate with health plans to ensure patients receive appropriate care.
The manager will design, implement, and maintain health information systems while leveraging data to improve healthcare outcomes. They will also coach the team on statistical analysis, data modeling, and the integration of new technologies to support clinical workflows.
The Senior Manager leads strategic initiatives and projects to achieve business objectives for the Health100 platform. They evaluate market segments and business models to identify new growth opportunities while communicating insights to senior executives.
You will design, develop, and implement digital solutions for the Aetna Health website while collaborating with cross-functional teams to deliver new features. Additionally, you will monitor and troubleshoot applications in production while providing mentorship to junior developers.
Coordinates case management activities with members to evaluate medical needs and facilitate overall wellness. Develops strategies to address health outcomes and ensures compliance with network management and clinical coverage policies.
The Behavioral Health Clinical Liaison manages utilization and coordinates care for Medicaid members while serving as a subject matter expert for behavioral health services. They collaborate with internal teams, community stakeholders, and providers to drive quality initiatives and ensure optimal member outcomes.
Coordinates case management activities for pediatric members to evaluate medical needs and facilitate overall wellness. Develops strategies to address health outcomes and ensures compliance with network management and clinical coverage policies.
Coordinates case management activities to evaluate medical needs and facilitate member wellness. Develops strategies to address health outcomes and ensures compliance with clinical coverage policies.
The Staff Systems Engineer will define and own the enterprise data architecture strategy across operational, analytical, and AI/ML workloads. They will also lead data governance, compliance, and cross-team collaboration to ensure reliable and scalable data infrastructure.
Provide psychosocial support, education, and evidence-based mental health therapy to individuals, couples, and families ages 13 and older. Collaborate with the clinical care team to develop treatment plans and ensure continuity of care for patients within their communities.
Conduct approximately 30-minute virtual video visits with health plan members to perform medication and medical history reviews. Provide education to members regarding their health needs and ensure high-quality clinical documentation and visit completion rates.
The Associate Manager oversees the Quality staff, focusing on team development, performance monitoring, and process improvement. They collaborate with functional managers to ensure consistency in reporting and facilitate effective communication within the Appeals team.
The Senior Manager will oversee the business control environment, lead governance activities, and manage risk across critical Service Operations processes. This role serves as a key liaison between business operations, internal and external auditors, and leadership to ensure effective control design and compliance.
The Case Manager conducts comprehensive assessments of member needs and develops collaborative care plans to meet health and social goals. They provide crisis intervention, facilitate care coordination, and advocate for members to ensure quality, cost-effective outcomes.
Conduct concurrent reviews for inpatient admissions to determine medical necessity and facilitate appropriate levels of care. Collaborate with healthcare providers and care teams to ensure timely discharge planning and effective resource utilization.
The Case Manager facilitates comprehensive health needs through assessment, planning, and care coordination for chronically ill or catastrophic cases. They act as a liaison between members, providers, and insurance carriers to optimize wellness outcomes and ensure appropriate benefit utilization.
The manager will lead and mentor a team of medical coders within the Special Investigations Unit to ensure compliance with coding standards and documentation requirements. They will oversee complex record reviews, identify billing patterns, and collaborate with investigators and leadership to address potential fraud and abuse.
The analyst will focus on analyzing financial and business risks, specifically supporting quarterly forecasting and monthly valuation for Medicare Part D products. They will collaborate with cross-functional teams to model risks and provide analytical support for legislative or regulatory reforms.
The Senior Manager will lead business delivery and enablement activities by orchestrating cross-functional teams and aligning technology investments with Oak Street Health's strategic goals. They are responsible for establishing governance processes, tracking measurable outcomes, and driving organizational readiness for technology-enabled operational changes.
Design, build, and support a near real-time transactional cache platform to enable efficient data consumption for APIs and digital services. Manage data replication pipelines from legacy systems to cloud-native environments while optimizing performance and reliability.
Review prior authorization requests by evaluating medical necessity using clinical records and evidence-based guidelines. Collaborate with interdisciplinary teams and providers to ensure timely, cost-effective, and quality healthcare services.
The Case Manager acts as a telephonic liaison between patients and their care teams to ensure appropriate benefit administration and quality care. They apply clinical judgment to assess member needs, reduce risk factors, and facilitate care planning through multidisciplinary collaboration.
The Senior Actuarial Analyst will manage and support system enhancements for the commercial rating engine, including documentation, testing, and implementation. They will also perform actuarial rate reviews, investigate pricing practices, and provide technical support for underwriting and actuarial rating issues.
The Senior Integrated Service Specialist acts as the primary point of contact for claims-related inquiries, providing accurate information and resolving member needs. They also manage work queues, monitor workflow, and facilitate referrals to in-network healthcare providers.
The Telephonic Registered Nurse will provide patient education and support regarding medications and disease management through outbound calls. They will collaborate with healthcare professionals to develop, implement, and evaluate comprehensive care plans for patients in a remote setting.
The role involves leading the design and delivery of enterprise-grade workforce management solutions, including demand forecasting and labor scheduling. You will partner with business stakeholders and engineering teams to configure platforms and ensure scalable, well-governed operational outcomes.
Conduct in-home health evaluations for patients, including medication reviews, medical history assessments, and physical examinations. Facilitate connections to appropriate care and document findings using an intuitive clinical workflow on an iPad.
The Utilization Management Nurse Consultant performs clinical reviews to evaluate medical necessity and coordinate care for patients. They also collaborate with providers, mentor new staff, and implement process improvements to enhance quality and client satisfaction.
The Patient Care Coordinator processes monthly patient refill requests and ensures accurate documentation for enteral nutrition orders. They also manage incoming calls from patients and providers while verifying insurance and demographic information to facilitate service admissions.
The Case Manager RN conducts comprehensive clinical assessments and develops individualized care plans to facilitate optimal health outcomes for members. They provide ongoing coaching, education, and advocacy while coordinating services and monitoring progress through a remote, queue-based environment.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The role involves reviewing, researching, and adjusting complex Reinsurance and Stoploss medical claims while collaborating with business functions to ensure accuracy. The adjuster will also handle customer inquiries, perform overpayment and underpayment reconciliations, and apply medical necessity guidelines to the adjudication process.
This role is responsible for developing and maintaining databases, data sources, and analytical tools to support actuarial, finance, and medical economics functions. The analyst will collaborate with cross-functional teams to design solutions and communicate complex data insights to various stakeholders.
The Data Scientist will develop and operationalize machine learning forecasting models to improve demand visibility and inventory decisions. They will collaborate with supply chain and technology teams to translate complex demand signals into actionable insights and scalable analytics products.
The Utilization Management Nurse Consultant assesses, plans, and coordinates healthcare services by applying clinical criteria to render coverage determinations. They also consult with providers and internal teams to ensure quality effectiveness and appropriate benefit utilization.
Conduct in-home health evaluations including medication reviews, physical assessments, and diagnostic screenings for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Collaborate with plan sponsor teams to gather and analyze client requirements, develop implementation plans, and coordinate internal departments to deliver successful onboarding projects. Serve as a primary client contact, address implementation inquiries, and lead and mentor the implementation team.
Provide evidence-based virtual care to patients aged 18 months and older, including assessment, diagnosis, treatment, health counseling, and disposition planning. Document care in the EHR and coordinate with patients, colleagues, and the broader care team to support continuity and quality of care.
The Lead Director serves as the principal strategic and operational advisor to the Chief Medical Officer, driving enterprise clinical priorities and organizational effectiveness. They coordinate cross-functional initiatives, manage complex projects, and develop executive-level communications to align provider operations with strategic goals.
The Lead Solution Architect will define the target-state architecture and roadmap for the enterprise customer communications ecosystem. This role involves designing scalable, compliant, and integrated platforms while partnering with engineering teams to modernize communication capabilities.
The Case Manager RN will conduct comprehensive clinical assessments and develop individualized care plans to support member health outcomes. They will also advocate for members, facilitate discharge planning, and collaborate with care teams to ensure high-quality, cost-effective service delivery.
The Project Manager will maintain enterprise accreditation readiness plans and coordinate NCQA steering committees. They are responsible for tracking gaps, managing evidence repositories, and preparing executive readiness updates.
The Business Analyst will design and implement client reporting solutions while managing data ingestion and technical troubleshooting. They will serve as the primary data owner for clients, ensuring data integrity and translating business objectives into actionable reporting requirements.
The Contract Negotiation Manager is responsible for negotiating, executing, and auditing complex provider contracts to meet network quality and financial goals. They also recruit providers and collaborate cross-functionally to manage network development and resolve escalated contractual issues.
The Case Manager is responsible for assessing, planning, and coordinating care for dual-eligible members to facilitate their overall wellness. They act as frontline advocates who collaborate with providers and community organizations to address complex health and social needs.
The Manager of Digital Operations oversees daily operational execution, ticket management, and incident communications for GPS and plug-in applications. This role also involves conducting experience analytics, supporting testing activities, and driving root-cause remediation in collaboration with Product and IT teams.
The Care Management Associate coordinates medical services by handling intake calls, verifying eligibility, and managing pre-certification cases. They also maintain accurate documentation and facilitate communication between patients, providers, and the clinical care team.
Serve as a primary contact for members, patients, providers, and third-party administrator clients by handling calls and email inquiries, providing claim updates, and sharing participation information. Educate providers and resolve customer concerns professionally and promptly while documenting interactions.
Provide clinical education and support to patients and caregivers regarding complex pulmonary arterial hypertension therapies. Collaborate with physicians, pharmacy operations, and sales teams to coordinate patient care plans in a home-based setting.
The Nurse Case Manager delivers comprehensive case management services through telephonic and face-to-face interactions to support member medical needs. They are responsible for assessing, planning, and coordinating care strategies while collaborating with multidisciplinary teams to optimize health outcomes.
The manager will lead complex, strategic initiatives from intake through implementation while partnering with business and technology leaders. Responsibilities include defining requirements, managing project scope and risks, and providing consultative guidance to senior stakeholders.
The analyst will build and maintain ETL workflows using Dataiku and Python to support data movement and business process integration. They will also collaborate with cross-functional teams to document requirements and resolve client issues through data investigation.
The Registered Nurse provides telephonic clinical support, including patient education on chronic conditions and medication adherence monitoring. They also collaborate with healthcare providers to resolve clinical issues and report adverse drug events.
Provide psychosocial support, education, and evidence-based counseling to patients aged 13 and older. Manage treatment planning and care collaboration while utilizing electronic health record systems to ensure continuity of care.
The Principal Engineer will lead enterprise-wide technology modernization, cloud adoption, and the responsible integration of AI capabilities. They will serve as a strategic advisor to engineering teams, establishing architectural standards and best practices to improve software delivery and operational efficiency.
Provide telehealth therapy and psychosocial support to patients aged 13 and older using evidence-based methodologies. Collaborate with the clinical care team to develop treatment plans and ensure continuity of care.
The Senior Manager will lead the development and execution of Omnicare's overall marketing, brand, and content strategy to articulate customer value. They will oversee creative direction, manage a small team, and partner with internal stakeholders to drive growth and engagement.
Provide psychosocial support and evidence-based mental health therapy to individuals, couples, and families aged 13 and older. Collaborate with clinical care teams to develop treatment plans and ensure continuity of care using virtual platforms.
Provide psychosocial support, education, and evidence-based mental health treatment to individuals, couples, and families aged 13 and older. Collaborate with clinical care teams to ensure continuity of care while maintaining autonomy in practice management.
Provide evidence-based mental health therapy and psychosocial support to individuals, couples, and families aged 13 and older. Collaborate with clinical care teams to develop treatment plans and ensure continuity of care through virtual platforms.
Provide psychosocial support and evidence-based mental health counseling to individuals, couples, and families aged 13 and older. Collaborate with clinical care teams to develop treatment plans and ensure continuity of care using digital health platforms.
The Associate Manager oversees healthcare management staff and ensures the implementation of high-quality, compliant clinical services. They are responsible for developing high-performing teams, monitoring care plans, and collaborating with functional area managers to meet operational and financial objectives.
Conduct in-home health evaluations for health plan members to bridge gaps in care and improve health outcomes. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining accurate clinical documentation using an iPad.
The Lead Director will oversee the operational health, performance, and security of the core network infrastructure, including routing, switching, and core network services. They will also lead and mentor a network operations team while driving strategic planning, automation initiatives, and problem management.
The Lead Director will oversee the strategy, modernization, and delivery of customer identity platforms across the enterprise. This role involves leading a multi-team engineering organization to drive cloud-native, AI-enabled identity solutions while ensuring operational excellence and security.
The Intake Coordinator is responsible for reviewing, researching, and entering grievance and appeal cases from various sources within one business day. They must manage cases according to specific state and plan requirements while collaborating with the Quality Assurance team to ensure accuracy.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and facilitate connections to appropriate care services to bridge gaps in health outcomes.
Provide psychosocial support and evidence-based mental health therapy to individuals, couples, and families aged 13 and older. Collaborate with clinical care teams to develop treatment plans and ensure continuity of care within a virtual environment.
The role involves administering and supporting enterprise IAM platforms, including Ping Identity, LDAP directory services, and authentication solutions. Responsibilities also include troubleshooting, automation, and providing 24x7 operational support for SSO, MFA, and related infrastructure.
Provide telehealth therapy and psychosocial support to patients aged 13 and older. Develop and implement evidence-based treatment plans while collaborating with the clinical care team.
The Senior Software Development Engineer is responsible for maintaining, supporting, and improving software applications through monitoring, incident resolution, and SRE practices. This role involves collaborating with cross-functional teams to ensure system stability, performance optimization, and the implementation of permanent technical solutions.
The Manager will lead the SOC Reporting team, overseeing the end-to-end execution of SOC 1 and SOC 2 audits. They are responsible for assessing IT and business risks, strengthening control environments, and partnering with stakeholders to implement audit improvements.
The Senior Analyst will manage payment integrity products, perform financial reporting, and conduct operational performance analysis. They will also collaborate cross-functionally to develop customized solutions and optimize process efficiency.
The Clinical Claims Review Nurse is responsible for reviewing and interpreting clinical documentation to apply appropriate criteria for post-service claims. They also act as a resource for internal teams, provide training, and identify trends or potential fraudulent activities.
The nurse will review and interpret clinical documentation to apply appropriate criteria for post-service claims and coordinate clinical resolutions. Additionally, the role involves acting as a resource for processing teams, training staff, and identifying trends or fraudulent activities.
The Senior Associate Epidemiologist will lead strategic research programs and cultivate partnerships with academic and public health institutions to advance real-world evidence generation. They will also manage complex healthcare datasets and contribute to scientific dissemination efforts including manuscripts and grant proposals.
The analyst supports the Security & Infrastructure team by managing strategic initiatives, executive communications, and organizational workflows. They are responsible for designing executive presentations, maintaining SharePoint portals, and developing clear, actionable content for diverse audiences.
The Sr Data Scientist translates complex clinical and EHR data into actionable performance measures and analytical frameworks. They collaborate with cross-functional teams to support quality, utilization, and population health initiatives across various clinical settings.
The Senior Investigator conducts complex investigations into healthcare fraud and abuse, including data mining and clinical reviews to prevent fraudulent payments. They also provide guidance to junior investigators and cooperate with law enforcement agencies during civil and criminal proceedings.
Design, build, and evaluate retrieval, generation, and agentic AI capabilities for CVS Health’s enterprise knowledge platform, using experimentation and production data to improve quality, relevance, and operational outcomes. Develop and integrate production-grade software, APIs, evaluation pipelines, and connectors while collaborating with engineering, product, and business teams.
The analyst implements quality management strategies and activities to meet internal and external health care outcomes. They perform quantitative and qualitative data analysis to report business information and recommend corrective actions for quality concerns.
You will lead strategic account management and operational initiatives for a portfolio of complex client relationships to drive satisfaction and growth. This role involves overseeing contract implementations, monitoring healthcare industry trends, and serving as a trusted advisor to clients and internal stakeholders.
The manager will oversee complex pharmaceutical rebate reconciliations, investigate payment variances, and resolve disputes with manufacturers. Additionally, they will provide mentorship to team members, lead cross-functional process improvement projects, and drive operational efficiency through automation.
The Clinical Claim Review Nurse evaluates clinical documentation and medical records to ensure claims align with regulatory requirements and clinical policies. They also coordinate clinical resolutions, provide feedback on trends, and act as a resource for internal teams.
The Senior Coordinator conducts regular audits of processes and products to ensure compliance with quality standards and regulatory requirements. They also lead new hire onboarding, upskilling training, and provide ongoing coaching to improve team performance.
Build relationships with client contacts and account team members to support renewals, customer retention, satisfaction, membership, and revenue. Execute account business-plan activities, coordinate client installations, and collaborate with internal teams to address service or complex product issues.
Provide virtual, evidence-based care to patients aged 18 months and older, including assessment, diagnosis, treatment, health counseling, and disposition planning. Document care in the EHR and coordinate with patients, colleagues, and the broader care team to support quality outcomes.
Support Account Executives in managing client relationships, analyzing account performance and market trends, and developing strategies to grow revenue and retain business. Coordinate with internal teams to deliver client projects and solutions, resolve issues, mitigate account risks, and improve client and member satisfaction.
Conduct comprehensive in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. Build trusted relationships with patients to provide personalized health guidance and support their overall well-being.
The Senior Manager will define and execute the enterprise observability platform strategy while leading engineering teams focused on reliability and platform services. They will drive the adoption of modern observability standards and partner with cross-functional teams to improve system availability and developer productivity.
The Staff Quality Engineer will develop and execute comprehensive test plans and test cases for healthcare applications. This role involves collaborating with stakeholders to ensure high-quality solutions through functional, regression, and data validation testing.
Lead medical benefit portfolio strategy, design, and execution for the Central Region, developing tailored solutions based on market opportunities and customer needs. Monitor portfolio performance, manage delivery priorities and risks, align cross-functional stakeholders, and lead change management and process improvement.
Lead claims, working capital, and balance sheet reconciliations, resolving variances and aged items while maintaining consistent procedures, controls, and audit-ready documentation. Support OPM, OIG, and external audits; collaborate with business and technology partners to improve data quality and automate reconciliation work; and mentor analysts.
The Nurse Case Manager conducts comprehensive assessments to develop and implement individualized care plans for members. They also coordinate care activities, educate members on health decisions, and collaborate with multidisciplinary teams to improve health outcomes.
The representative will verify insurance coverage for new and existing patients and process prescription orders in a timely manner. They are also responsible for providing excellent customer service to patients, healthcare professionals, and insurance carriers.
The Accounts Receivable Collector manages outstanding consumer account balances through professional outreach and effective communication. They are responsible for resolving past-due balances, documenting collection activities, and identifying appropriate payment solutions while maintaining compliance.
Conduct approximately 45-minute in-home health evaluations, including medication and medical history reviews, physical evaluations, and plan-indicated diagnostic or preventive services. Build trusted relationships with members, help identify care needs and connect them with appropriate care, and conduct virtual visits or travel locally as needed.
The associate will perform intake of calls from providers and members, utilizing various Aetna systems to research and document information. They will also collaborate with clinical teams and medical directors to process referrals, authorizations, and outreach for transplant and therapy services.
The individual will manage 837 file transmissions to state agencies and ensure all transactions are complete and error-free. They will also act on state response files to maintain accurate data processing for the DSNP business.
The Senior Analyst provides analytical and operational support to underwriting leadership by investigating drivers of change in pricing and forecasting models. This role involves cross-functional coordination, data extraction, and the creation of clear readouts to facilitate informed decision-making.
Design, build, and operate secure, resilient, high-volume backend microservices and event-driven integrations for healthcare data exchange. Lead production readiness and reliability, implement CI/CD and observability practices, ensure regulatory compliance, and collaborate across teams while mentoring engineers.
The Contract Coordinator Analyst manages the provider contracting lifecycle, including reviewing contractual documents and maintaining provider records in internal databases. They also ensure regulatory compliance, respond to provider inquiries, and support internal auditing processes.
Perform concurrent reviews for acute inpatient admissions to evaluate medical necessity and level of care using evidence-based criteria. Collaborate with healthcare providers and care teams to facilitate discharge planning and ensure appropriate transitions of care.
The Account Coordinator analyzes client requirements to determine appropriate system setups and ensures alignment with internal processes and vendor partners. They also manage the installation process, perform UAT testing, and generate reports to meet client and business goals.
The Staff Software Engineer will lead the development of intelligent, cloud-native Agentic AI solutions to automate complex business processes and improve operational efficiency. They will provide technical leadership, mentor junior staff, and establish best practices for AI integration and software architecture across the organization.
The Senior Certified Professional Coder will conduct comprehensive medical record audits to ensure compliance with coding practices and identify potential billing errors or fraud. They will also mentor new coders and collaborate with investigators, legal counsel, and plan leadership to resolve complex coding issues.
The Appeals Nurse Consultant is responsible for reviewing and resolving clinical appeals by applying sound clinical judgment and regulatory criteria. They coordinate clinical resolutions with internal and external support teams for member and provider issues.
The Case Manager RN provides comprehensive care management services to members with complex medical, behavioral, and social needs. They are responsible for conducting clinical assessments, developing person-centered care plans, and coordinating care across providers and community resources.
The Sr. Analyst is responsible for financial performance management, KPI governance, and operational forecasting for the CVS Middle Mile transportation network. This role connects operational decisions to financial outcomes and identifies continuous improvement opportunities across private and dedicated fleet operations.
The Appeals Nurse Consultant is responsible for reviewing and resolving clinical appeals by interpreting clinical records and applying appropriate criteria. They coordinate clinical resolutions with internal and external support teams to ensure fair and accurate outcomes.
Design, develop, and deploy scalable AI and Generative AI solutions using cloud-native services and modern software engineering practices. Collaborate with cross-functional teams to integrate enterprise knowledge into AI applications while ensuring compliance with security and governance standards.
Review and coordinate medical management cases, applying clinical criteria, guidelines, and plan policies to determine medical necessity or refer cases to a Medical Director. Support training and cross-training, and contribute to audits, process improvements, and quality and productivity goals.
The Customer Service Representative handles inquiries from members, providers, and plan sponsors via telephone, internet, or written correspondence. They are responsible for educating members on health plans, resolving issues, and documenting contacts while maintaining regulatory compliance.
Lead, coach, and develop software engineering teams while managing staffing, capacity, talent, and vendor resources. Oversee secure, high-quality software delivery across the development lifecycle, partnering with product, architecture, security, operations, and business stakeholders to improve reliability and outcomes.
Manage a portfolio of business-to-business receivables by contacting clients, researching and reconciling account issues, and developing resolution strategies for delinquent balances. Maintain accurate collection records, collaborate with internal teams to improve outcomes, monitor account trends, and support compliance and process improvement.
Conduct Medicaid-wide analyses and reporting, identify opportunities for cross-market analysis and standardized plan reporting, and automate existing reporting. Support Medicaid health plans and finance teams with proposals for new and renewing business, and communicate analytical results to varied audiences.
The Senior Manager will provide strategic leadership for the digital engineering function, overseeing project delivery, technical roadmaps, and team development. They will collaborate with stakeholders to align technical solutions with business goals while fostering a culture of innovation and continuous improvement.
The Care Management Associate manages member enrollment for child and family welfare populations and coordinates medical services through the development of wellness plans. They perform outreach, triage members, and ensure accurate documentation in compliance with regulatory and accreditation standards.
The Quality Management Nurse supports the development and implementation of quality improvement and patient safety initiatives to ensure regulatory compliance. They collaborate with cross-functional teams to analyze clinical data and promote evidence-based practices to enhance healthcare outcomes.
The Senior Manager will oversee quarterly and annual GAAP and STAT income tax provisions and manage federal tax compliance processes. They will also assist in tax planning, strategy development, and modeling the impact of tax law changes on the company.
The Pharmacy Technician acts as a liaison between patients, providers, and pharmacists to manage medication refills and renewals. They are responsible for handling high-volume inbound and outbound calls while documenting patient information accurately in electronic medical records.
The Pharmacy Technician acts as a liaison between patients, providers, and pharmacists to manage medication refill requests and investigate status updates. They are responsible for handling high-volume inbound and outbound calls while documenting patient information accurately in electronic medical records.
Process pharmacy prior authorization requests, conduct clinical research using medication guidelines and other resources, and complete approvals, denials, and renewals with accurate documentation. Respond to inquiries from providers, pharmacies, and internal partners while meeting productivity, quality, and timeliness expectations.
Lead Agile delivery for ServiceNow teams by facilitating Scrum ceremonies, coordinating sprint and release execution, refining backlogs with stakeholders, and aligning delivery with business priorities. Coach teams, remove impediments, manage risks and dependencies, report progress transparently, and use performance metrics to improve delivery quality and predictability.
Lead financial forecasting, budgeting, accruals, variance analysis, and rebate analytics while managing analyst deliverables and ensuring reporting accuracy. Partner with data and technology teams to build cloud-based financial data solutions, automated pipelines, validation and reconciliation processes, and enterprise reporting that improve decision-making and data governance.
Conduct clinical utilization reviews to assess medical necessity, appropriateness, and efficiency of care, and make decisions using evidence-based criteria and applicable policies. Coordinate care with providers and internal teams, manage decision letters and documentation, and contribute to quality improvement and guidance for healthcare professionals.
Conduct approximately 45-minute in-home health evaluations, including medication and medical history reviews, physical evaluations, and plan-indicated diagnostic or preventive services. Build trusted relationships with members, help connect them to appropriate care, conduct virtual visits as needed, and travel locally within licensed states.
Lead provider data, membership, and attribution governance to ensure accurate operational outputs, resolve issues affecting member assignment and downstream processes, and support directory accuracy and regulatory readiness. Coordinate across health plan, provider, claims, compliance, analytics, operations, and technology teams to identify root causes, close control gaps, and improve operational reliability.
Coordinate the Root Cause Corrective Action program by supporting root cause analysis, tracking corrective actions, assessing business impacts, and collaborating with cross-functional teams to resolve recurring complaints, grievances, and appeals. Manage project planning, governance documentation, stakeholder communications, and executive reporting while recommending sustainable process improvements that strengthen operational performance and member outcomes.
The Referral Coordinator manages day-to-day referrals and diagnostic orders to ensure patients access specialist care in a timely manner. They are responsible for updating electronic medical records, obtaining authorizations, and coordinating with internal teams and payer partners.
Conduct second-level audits of medical records coded by internal teams and vendors to verify that risk-adjustment ICD codes are accurate, supported by clinical documentation, and compliant with regulations and internal policies. Communicate audit findings and documentation deficiencies, educate and mentor colleagues, and perform process audits while meeting deadlines and supporting quality improvement.
Lead enterprise-wide governance of Utilization Management policies, procedures, workflows, job aids, templates, letters, forms, and content repositories across multiple lines of business. Direct intake, prioritization, approvals, publication, performance measurement, stakeholder coordination, and continuous improvement while leading and developing the governance team.
Conduct quality audits of pre-service complaints, grievances, and appeals to assess regulatory compliance, analyze trends, and identify root causes and operational risks. Develop reports and recommendations, guide corrective actions and remediation, and collaborate with cross-functional teams to improve processes, member experience, and operational performance.
Lead the architecture, operation, security, and strategic evolution of the Azure Databricks platform, including monitoring, incident response, governance, performance, and cost optimization. Automate platform provisioning and deployment, enable and mentor data engineering teams, collaborate across technical and business groups, and direct the work of two platform engineers.
Manage projects to replace critical operations equipment, maintain facility systems, and design and implement material handling systems across the distribution center network. Ensure regulatory compliance, prioritize capital investments, manage budgets and expenditures, support operations engineering, and promote safety and consistent policy adherence.
Audit and abstract medical records to verify that ICD diagnosis codes submitted for risk adjustment are accurate, clinically supported, and compliant with regulations and internal policies. Review documentation for active versus historical conditions, support coding decisions with industry-standard evidence, and complete audits within required timelines.
Lead and contribute hands-on to the design and delivery of scalable digital platforms, microservices, APIs, and proof-of-concept solutions that address customer and business needs. Guide engineering quality through code reviews, technical support and root-cause analysis, collaboration with business and IT leaders, and mentorship of junior developers.
Coordinate case management and psychosocial care for members with acute or chronic conditions, including assessments, individualized care plans, referrals, home visits, and connections to community resources. Collaborate with healthcare providers and community organizations to improve outcomes, prevent avoidable admissions, support community integration, and coach junior colleagues.
This role serves as a strategic partner for the Enterprise Workforce Management team, focusing on the maintenance and innovation of business practices and volume drivers. The analyst will develop reporting, modeling, and data visualization to support labor budgeting and forecasting initiatives.
The Strategic Account Executive serves as the senior liaison for the Federal Employee Program Specialty Pharmacy line of business, leading account teams to ensure client satisfaction and service delivery. They are responsible for developing financial performance reports, identifying cost-saving opportunities, and building strong relationships with key client stakeholders.
The Clinical Case Manager coordinates care for members with chronic conditions or psychosocial needs to prevent re-admissions and improve health outcomes. They are responsible for developing individualized case plans, conducting home visits, and collaborating with healthcare providers and community resources.
Manage the end-to-end reasonable accommodation process, including individualized assessments, interactive discussions, medical documentation review, case records, and implementation. Advise and partner with employees, managers, HR, and Legal to deliver timely, compliant accommodations and support a positive employee relations experience.
This role supports the Medicaid provider management team by coordinating work assignments, reporting, and project management tasks. The coordinator will collaborate across teams to manage intake, triage, and provider data assignments while ensuring production turnaround times are met.
The Health Plan Manager oversees client relationships and delivers client satisfaction through timely and accurate interactions. They are also responsible for hiring, training, and mentoring a team of Account Managers to drive performance and professional development.
The manager will develop, maintain, and optimize reporting solutions, dashboards, and cloud-based analytic assets to support business decision-making. They will collaborate with cross-functional teams to deliver financial and operational insights while ensuring data quality and infrastructure reliability.
The Utilization Management Nurse Consultant reviews clinical documentation and applies evidence-based criteria to support coverage determinations. They also collaborate with providers and care teams to coordinate healthcare services and improve member health outcomes.
The Senior Configuration Manager leads the end-to-end lifecycle of digital product customizations, from discovery and solution definition to testing and release. This role translates business needs into functional requirements and collaborates with cross-functional teams to ensure scalable, high-quality member experiences.
The role supports business analytics strategies by managing data governance, quality assurance, and reporting initiatives. It involves coordinating cross-functional projects and ensuring data accuracy across technical and business teams.
The Care Coordinator oversees daily operations of the Utilization Management department to drive process improvements and optimize workflows. They collaborate with physician reviewers, external payers, and vendors to ensure quality care delivery and meet performance metrics.
The Senior Analyst is responsible for analyzing provider reimbursement arrangements and executing fee schedule negotiations to optimize PPO network performance. They will leverage claims and market data to develop strategies that improve discount outcomes while maintaining network adequacy.
The Medical Claim Analyst is responsible for the initial review, triage, and eligibility determination of medical claims. They also maintain accurate documentation and assist in the research and resolution of payment issues while adhering to regulatory standards.
Review clinical information and apply evidence-based criteria to support coverage determinations while assessing and coordinating healthcare services. Collaborate with providers and care teams to facilitate treatment plans and identify opportunities to improve quality and efficiency.
Lead end-to-end UX design initiatives for the Outreach & Execution product organization, from research to implementation. Collaborate with cross-functional teams to translate user insights into intuitive, engaging design solutions that meet business objectives.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The manager oversees the application and data technology stack within Google Cloud, ensuring reliability, security, and performance. They design and maintain CI/CD pipelines, manage data pipelines, and leverage AI to automate workflows and operational tasks.
The Principal Architect will define and implement strategic technology roadmaps with a focus on applied AI, cloud infrastructure, and microservices to drive business value. They will also provide technical leadership, mentorship, and architectural governance to ensure high-quality, scalable, and secure software delivery across the organization.
The Executive Director defines and executes the enterprise-wide strategy for cyber detection, response, and incident management. They lead the Security Operations Center and CSIRT while serving as the Incident Commander for major security events.
The Pharmacy Account Executive serves as the senior liaison for PBM clients, managing strategic account teams to ensure client satisfaction and service delivery. They are responsible for growing business through renewals, retention, and up-selling solutions while maintaining strong relationships with key stakeholders.
The role involves owning analytics strategy and influencing product direction by working closely with the Clinician Enablement & Ecosystem team. You will deliver measurable business impact through data-driven decision-making, reporting, and light experimentation to optimize product experiences.
The Medical Director provides psychiatric leadership and physician oversight for utilization management teams, focusing on high-risk cases and medical necessity decisions. They also participate in clinical quality improvement activities and assist in the development of medical policies and clinical practice guidelines.
Provides dedicated executive-level administrative and operational support to two Vice Presidents. Manages complex calendars, coordinates meetings, and facilitates communication across internal and external stakeholders.
The Senior Analyst will drive the adoption of Knowledge-Centered Service (KCS) practices and establish governance standards across technical support and engineering teams. They will act as a liaison to identify knowledge gaps, map workflows, and ensure content is optimized for enterprise AI ingestion.
The Staff Software Development Engineer will design, develop, and implement digital solutions while managing the application development team's day-to-day operations. They are responsible for defining long-term application strategy, ensuring high-quality delivery, and collaborating with cross-functional teams to drive innovation.
The Lead Director oversees the Solutions Delivery function, ensuring the successful commercialization and execution of analytics products for pharmaceutical clients. This role manages end-to-end delivery governance, portfolio financial performance, and cross-functional collaboration to drive operational scalability and client satisfaction.
Coordinates member outreach to ensure effective use of health plan benefits and receipt of clinical services. Responds to member inquiries and supports HEDIS quality initiatives and medical record abstraction.
Coordinates member outreach to ensure effective use of health plan benefits and receipt of important clinical services. Responds to member inquiries and supports HEDIS quality initiatives and medical record abstraction.
The FP&A Analyst supports budgeting, forecasting, and financial analysis of SG&A expenses for the Medicaid Finance Team. They are responsible for creating variance reports, financial models, and presenting data to leadership to drive corporate decisions.
The Senior Manager manages the day-to-day execution of analytics solutions for pharmaceutical clients, serving as the primary contact for delivery coordination. They oversee implementation activities, manage risks, and drive cross-functional collaboration to ensure high-quality, on-time project delivery.
The Utilization Management Nurse Consultant reviews clinical information and applies evidence-based guidelines to make coverage recommendations. They also coordinate with providers and care teams to support treatment plans and ensure continuity of care.
The Lead Director will define the digital product vision and strategy while managing the end-to-end product development lifecycle. They will also translate complex business questions into causal analytical models and provide decision-ready recommendations to senior leadership.
The Medical Director will oversee Medicaid appeals, ensuring timely and consistent responses to member and provider grievances. They will provide clinical expertise to the appeals team and chair committee meetings regarding medical necessity.
The Nurse Practitioner will provide holistic, evidence-based virtual care, including assessment, diagnosis, and treatment for patients aged 18 months and older. They will also manage patient health inquiries, provide counseling on preventative care, and document all interactions within an electronic health record system.
The role involves designing and implementing digital solutions by architecting software applications and integrating cloud-native SaaS with core clinical systems. You will also collaborate with cross-functional teams to automate Payer lifecycle contracts and optimize Payer operations using AI/ML.
Review clinical cases and make coverage determinations using evidence-based criteria while collaborating with interdisciplinary teams. Identify opportunities to improve quality, outcomes, and member experience through clinical judgment and prior authorization decisions.
Lead the end-to-end architecture and development of scalable web applications while integrating AI-driven features and complex data systems. Drive technical strategy, mentor engineering teams, and ensure operational excellence across cloud infrastructure and DevOps practices.
The analyst will manage 837 file transmissions to state agencies and ensure all transactions are complete and error-free. They are responsible for managing and acting on state response files and performing necessary error corrections to meet state requirements.
Own the partner-channel scheduling product roadmap, developing configurable APIs, agent-assisted scheduling, and embedded SDK capabilities that enable partners to book and manage in-home evaluations. Coordinate partner integrations and launches across internal teams and clients, use research and KPIs to guide decisions, and transition mature capabilities to core scheduling teams.
Execute and document assigned compliance monitoring activities, including complex reviews of medical records, claims, diagnosis codes, and supporting documentation to assess coding accuracy, risk adjustment, and compliance. Coordinate reporting, issue follow-up, and communication of compliance risks and business impacts to stakeholders.
Lead teams responsible for complaints and appeals, overseeing daily operations, budgets, staff development, training, audit readiness, and compliance with applicable regulations. Develop audit tools, policies, procedures, and system requirements; monitor appeals workflows and timeliness; and collaborate across departments to improve quality and customer satisfaction.
Review and adjudicate complex medical and pharmacy claims, make claim adjustments, and resolve overpayments, underpayments, refunds, and other discrepancies. Handle provider and customer inquiries, interpret contract terms, ensure compliance, and may provide job shadowing to less experienced staff.
The Case Manager RN performs clinical assessments, develops individualized care plans, and coordinates services to ensure optimal, cost-effective health outcomes for members. They also advocate for patients, provide health coaching, and monitor progress to facilitate effective discharge planning and ongoing support.
The IT Audit Analyst will document and evaluate SOX IT general controls while developing an understanding of risk assessment and financial frameworks. They will also communicate findings to stakeholders and collaborate with Internal Audit management to ensure audit objectives are met.
The role involves assisting in the development and support of applications while utilizing automation tools to improve system efficiency. You will collaborate with cross-functional teams to deliver high-quality code and implement new technologies within an Agile framework.
The RN Case Manager conducts comprehensive clinical assessments and develops collaborative care plans to meet member health needs and benefit goals. They utilize motivational interviewing and crisis intervention strategies to ensure quality care and facilitate appropriate treatment services.
The Manager, Digital Product will lead the development and enhancement of digital products by defining product direction and translating stakeholder requirements into actionable solutions. They will collaborate with cross-functional teams to drive product strategy, monitor performance through data analytics, and ensure alignment with business objectives.
The RN Case Manager is responsible for assessing, planning, and coordinating case management activities to evaluate member medical needs and facilitate wellness. They develop proactive courses of action, conduct evaluations of benefit plan eligibility, and utilize clinical judgment to address complex health indicators.
The associate counsel will negotiate non-disclosure agreements and pharmacy benefit services contracts while providing legal guidance on PBM industry regulations. They will collaborate with internal departments and support client relationships to facilitate new business opportunities.
The analyst identifies and develops potential healthcare fraud, waste, and abuse leads through data mining and claims analysis. They evaluate billing patterns and translate complex data into actionable investigative leads for leadership.
The Recovery Savings Analyst is responsible for managing overpayment inventory and conducting provider outreach to recover and allocate overpaid funds. They will perform complex claim adjustments, interpret provider contracts, and ensure all recovery activities align with compliance and company policies.
The specialist is responsible for researching, reviewing, and correcting pharmacy-related claim issues to ensure financial accuracy and regulatory compliance. They also execute business support tasks and identify irregularities such as overpayments or underpayments.
The role involves building validated data assets and analysis pipelines to track the impact of GenAI/ML products on clinical and operational outcomes. You will act as a bridge between clinical concepts and analytical frameworks while partnering with data engineering to optimize data ingestion and storage.
The Medical Director provides clinical expertise to support medical policy, transactional reviews, and the clinical claim review process. They also participate in work groups to improve the quality and efficiency of health care services while ensuring alignment with company policies.
The Accounts Receivable Collector manages outstanding consumer account balances through professional outreach and effective communication. They are responsible for resolving billing discrepancies, documenting collection activities, and negotiating payment arrangements with customers.
The Appeals Nurse Consultant is responsible for the intake, investigation, and resolution of clinical appeals, complaints, and grievances. They must interpret clinical documentation and data to apply appropriate criteria while coordinating with internal and external stakeholders to ensure regulatory compliance.
The Medical Director will perform utilization management, medical necessity reviews, and prior authorization determinations for Medicaid members. They will also collaborate with multidisciplinary clinical teams and participate in a rotating on-call schedule.
The coordinator is responsible for the intake, investigation, and resolution of member and provider appeals, complaints, and grievances. They must identify trends, coordinate responses across business units, and ensure timely, customer-focused resolutions.
Acts as the primary resource for high-profile providers to maintain positive relationships and resolve complex issues regarding Medicaid policies, claims, and contract parameters. Collaborates cross-functionally to manage cost drivers, execute cost initiatives, and ensure provider compliance with plan designs and regulatory standards.
The Lead Director of Recruitment Operations serves as the primary interface between clients and internal teams to implement and deliver clinical recruitment projects. They are responsible for developing recruitment strategies, managing client relationships, and leading cross-functional teams to achieve project goals.
The Utilization Management Nurse Consultant assesses and coordinates healthcare services by applying clinical criteria to render coverage determinations. They collaborate with providers and internal teams to facilitate appropriate care and identify opportunities for quality improvement.
Provide remote, evidence-based care to patients aged 18 months and older, including assessment, diagnosis, treatment, health counseling, and disposition planning. Document care in the electronic health record and coordinate with patients, colleagues, and the broader care team to support continuity and quality of care.
The nurse consultant will review clinical information and apply evidence-based criteria to support coverage determinations and care coordination. They will also collaborate with providers and interdisciplinary teams to facilitate appropriate, high-quality healthcare services.
You will partner with engineering, product, and design teams in an agile environment to transform ideas into reality. The role involves utilizing modern methodologies and open-source tools to build scalable, cloud-native applications that impact patients and teams.
The Associate Manager oversees healthcare management staff to ensure high-quality, consistent interventions and compliance with regulatory standards. They are responsible for managing resources, developing care plans, and fostering a collaborative team environment to meet operational and financial objectives.
The coordinator is responsible for the intake, investigation, and resolution of member and provider appeals, complaints, and grievances. They must identify trends, coordinate responses across business units, and ensure timely, customer-focused communication.
The coordinator is responsible for the intake, investigation, and resolution of appeals, complaints, and grievances for various health products. They must identify trends, coordinate responses across business units, and ensure timely, customer-focused resolutions.
The coordinator is responsible for the intake, investigation, and resolution of member and provider appeals, complaints, and grievances. They must identify trends, coordinate responses across business units, and ensure timely, accurate communication for final resolution.
The representative will act as an advocate for customers by resolving inquiries, educating them on benefits and claims, and documenting all interactions. They will collaborate with team members to provide proactive solutions and ensure high levels of customer satisfaction.
Oversee utilization review and quality assurance, including authorization, concurrent, peer-to-peer, predetermination, and appeal reviews, and provide clinical, coding, and reimbursement expertise. Support the development and implementation of medical management programs, guide case management when needed, and serve as a clinical and business liaison to network providers and facilities.
Provide virtual, evidence-based care to patients aged 18 months and older, including assessment, diagnosis, treatment, counseling, medication management, and disposition planning. Document care in the EHR and coordinate with patients, providers, pharmacists, and other members of the care team.
Define and execute omnichannel commercialized solutions strategy, identifying opportunities and developing business cases for clinical interventions and customer-focused solutions. Lead pilot evaluation and performance optimization, partner across functions to deliver initiatives, and coach a high-performing team while presenting actionable recommendations to senior leaders.
Lead and develop teams of Account Executives and Strategic Account Executives responsible for complex employer PBM accounts, setting priorities and ensuring strong client relationships and execution. Own portfolio-level growth, retention, and profitability while guiding renewals, expansions, financial strategy, escalations, and cross-functional collaboration.
The Quality Management Nurse Consultant develops and implements quality improvement programs to monitor healthcare services and ensure alignment with regulatory and accreditation standards. They also facilitate workgroups and analyze organizational performance to drive evidence-based interventions that improve patient outcomes and HEDIS/CAHPS performance.
The Sales Executive builds strategic partnerships with brokers to drive profitable growth and cross-sell medical and ancillary products. They manage prospect pipelines, deliver polished presentations, and coordinate with internal teams to ensure successful sales and installation.
The Case Management Coordinator facilitates healthcare outcomes by evaluating member needs, coordinating care plans, and assisting with benefit access. They utilize critical thinking and motivational interviewing to engage members and ensure appropriate medical care and quality standards are met.
The Group Medicare Underwriter performs complex risk assessment and pricing analysis for Medicare Advantage customers. This role acts as a strategic partner to sales and account management teams to drive growth and ensure sound underwriting practices.
The Lead Director will oversee the development and delivery of enterprise risk adjustment analytics and business intelligence solutions to drive provider performance and operational efficiency. This role involves leading a team to transform complex healthcare data into actionable insights while partnering with executive stakeholders across finance, clinical, and operational departments.
Conduct comprehensive in-home health evaluations, including medication reviews, medical history assessments, and physical examinations for health plan members. Provide patient education and facilitate connections to appropriate care services to improve overall health outcomes.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide health education.
The Clinical Support Coordinator provides non-clinical administrative support to clinical teams to ensure efficient coordination of patient care activities. This role manages administrative workflows, maintains patient records, and supports therapy-related processes while ensuring compliance with regulatory standards.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
The Case Manager RN performs clinical assessments, develops care plans, and coordinates services to meet member health needs while promoting cost-effective outcomes. They also provide coaching and education to empower members to make informed medical and lifestyle choices.
The Case Manager RN conducts comprehensive clinical assessments and develops individualized care plans to promote optimal, cost-effective health outcomes. They provide ongoing coaching, education, and support to members while coordinating services and advocating for patient needs within their benefit plans.
The Case Manager RN performs clinical assessments, care coordination, and discharge planning to promote cost-effective health outcomes. They also provide coaching and support to members to ensure engagement with their benefit plans and healthy lifestyle choices.
The Data Scientist will analyze clinical data to develop and validate machine learning and generative AI solutions for healthcare applications. They will collaborate with cross-functional teams to implement these models while ensuring clinical rigor and adherence to regulatory standards.
The Lead Director oversees the data science strategy for underwriting transformation, focusing on financial integrity, forecasting accuracy, and risk management. They lead a team of 10+ data scientists to develop predictive models and analytical tools that support underwriting and sales decision-making.
The Senior Engineer will deliver high-quality web applications, interactive dashboards, and backend integration services. They will collaborate with engineering, data, and product teams to build modern user interfaces and embed AI capabilities into the application ecosystem.
The Lead Director of Quality Management provides strategic leadership for quality improvement, regulatory compliance, and population health strategies for Kentucky Medicaid. This role drives measurable improvements in quality outcomes, member experience, and provider performance while ensuring readiness for state and federal audits.
The clinician will review behavioral health treatment plans to ensure medical necessity and coordinate care decisions with providers. They will also provide triage support, facilitate discharge planning, and monitor members at risk for poor outcomes.
Lead the end-to-end architecture, development, and scaling of core applications while bridging backend data systems with intuitive frontend experiences. Champion the integration of AI/ML technologies and drive DevOps best practices to ensure operational excellence and rapid release cycles.
The Managing Senior Counsel will lead the privacy legal and compliance team to provide strategic counsel on healthcare privacy regulations and laws. They will identify legal risks, manage privacy incidents, and oversee data governance initiatives for the CVS Caremark business.
The Utilization Management Nurse Consultant assesses, plans, and coordinates healthcare services to ensure appropriate benefit utilization for members. They apply clinical criteria to render coverage determinations and collaborate with providers to facilitate effective care.
The role involves providing dedicated administrative and operational support to health plan partners by managing meeting cadences, documentation, and client inquiries. You will act as a subject matter expert for member journey processes and collaborate with internal teams to ensure seamless account execution.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct in-home health evaluations, including medication reviews, medical history assessments, and physical evaluations for health plan members. Facilitate connections to appropriate care and document findings using an intuitive clinical workflow on an iPad.
The nurse consultant will assess, plan, and coordinate healthcare services by applying clinical criteria to render coverage determinations. They will also communicate with providers and identify opportunities to promote quality effectiveness in benefit utilization.
The nurse consultant assesses, plans, and coordinates healthcare services for members by applying clinical criteria to render coverage determinations. They also collaborate with providers to facilitate treatment and identify opportunities to improve quality and benefit utilization.
The Senior Network Medical Director will serve as the primary clinical leader for provider relationships in the West Region, driving performance in cost, quality, and member experience. They will collaborate with network and analytics teams to shape engagement strategies and ensure compliance with regulatory requirements.
The Senior Network Medical Director will serve as a clinical leader for healthcare provider relationships in the Central Region, focusing on cost, quality, and member experience. They will collaborate with network and analytics teams to shape engagement strategies and ensure performance goals are met across various lines of business.
Direct Medicare Part C appeals, support appeal nurses and the Second Look Review process, and provide rotational after-hours and weekend coverage. Monitor IRE activity, support utilization management strategy, collaborate with quality and compliance teams, educate staff on Medicare policy, and improve appeals efficiency and clinical consistency.
Lead utilization review and quality assurance activities, direct case management, and provide clinical expertise and business direction for medical management programs. Serve as a clinical and business liaison to providers and facilities, and conduct predetermination and claims reviews using clinical, coding, and reimbursement expertise.
Assess, coordinate, and manage care for members with complex medical needs, developing proactive care plans and addressing clinical, social, and functional barriers. Collaborate with members, providers, and interdisciplinary teams, using clinical judgment and telephonic coaching to support effective care and utilization management.
Support pharmacy benefit clients through plan changes, ID card facilitation, reporting, invoices, documentation, implementation activities, and external-facing meetings. Assist members by handling calls, overrides, prior authorization and accessibility processes, claims issues, eligibility changes, and assigned service warranties.
The Transition of Care Registered Nurse facilitates seamless transitions for high-risk members between institutional and community settings to reduce readmissions. They lead interdisciplinary care teams to develop individualized care plans and address health-related social needs.
Conduct in-home health evaluations for health plan members to bridge gaps in care and improve health outcomes. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining detailed clinical documentation.
The analyst will conduct comprehensive evaluations of member needs and coordinate care plans to facilitate appropriate healthcare outcomes. They will also provide coaching and support to members while collaborating with multidisciplinary teams to overcome barriers to health goals.
Conduct telephonic assessments to evaluate member needs and develop individualized care plans to improve health outcomes. Coordinate care across providers and community resources while ensuring compliance with regulatory and company standards.
The Senior Software Development Engineer leads the design, development, and implementation of cloud-native, microservices-based digital solutions. They collaborate with cross-functional teams to drive technical innovation while mentoring peers and ensuring the scalability of health-focused applications.
The Senior Software Development Engineer will lead the design, development, and implementation of cloud-native, microservices-based digital solutions. They will collaborate with cross-functional teams to drive technical innovation and mentor peers while ensuring scalable and maintainable software delivery.
The Patient Intake Coordinator manages the initial admission of patients, coordinating workflow between branches, sales staff, and insurance verification teams. They process orders, assess patient needs, and communicate insurance coverage details to referral sources and patients.
The Staff Software Engineer will design, deliver, and operate business-critical distributed systems within a collaborative team. They will focus on building innovative solutions for a unified technology platform to support value-based healthcare.
The nurse consultant assesses, plans, and coordinates healthcare services to facilitate appropriate member benefits and care. They apply clinical criteria to render coverage determinations and consult with providers to ensure quality and effective healthcare utilization.
The Vice President of FP&A will lead financial planning, budgeting, and forecasting for the $20B retail business while driving operational efficiency and strategic growth. This role involves managing a complex finance organization, mentoring talent, and providing actionable financial insights to senior leadership to support decision-making.
The Clinician Operations Manager coordinates operational activities, manages staffing levels, and ensures efficient resource utilization across teams. They also monitor performance metrics, drive process improvements, and ensure compliance with quality standards.
The Senior Clinical Strategist leads clinical performance improvement projects for Medicare Provider Collaboration groups to enhance population health and quality metrics. They serve as a clinical liaison, interpreting data and strategizing with internal and external teams to drive outcomes and close gaps in care.
The Clinician Operations Manager coordinates operational activities, manages staffing levels, and ensures efficient resource utilization across teams. They also monitor performance metrics, drive process improvements, and ensure compliance with quality standards.
The manager leads and executes clinical informatics projects, focusing on EHR policy development, workflow standardization, and enterprise-wide assessment of AI-enabled tools. This role acts as a bridge between clinical operations, quality and safety teams, and IT leadership to ensure efficient and safe healthcare delivery.
The Clinician Operations Manager coordinates operational activities, manages staffing levels, and ensures efficient resource utilization across teams. They also analyze performance metrics, drive process improvements, and ensure compliance with quality control standards.
The Case Management Coordinator assesses, plans, and coordinates medical and wellness activities for members through both telephonic and face-to-face interactions. They apply clinical judgment to develop care plans, address health barriers, and facilitate transitions to appropriate Aetna programs.
The Manager, Clinical Health Services oversees clinical team processes and develops high-performing teams to drive quality healthcare outcomes. They are responsible for implementing health services strategies, ensuring compliance with policies, and managing the financial and operational objectives of the unit.
You will design robust system prompts using LLM frameworks and build file-ingestion pipelines using Databricks. Additionally, you will own domain-specific services, lead code reviews, and mentor junior and mid-level engineers.
Provide one-on-one home infusion nursing care and patient education in accordance with the physician's plan of treatment. Manage infusion therapies and document patient care activity using Microsoft Office tools.
The analyst facilitates healthcare outcomes by providing care coordination, support, and education to members using care management tools. They also conduct comprehensive evaluations of member needs and collaborate with multidisciplinary teams to ensure quality of care.
The Senior Practice Manager leads a team of NPs, PAs, and LVNs/LPNs to ensure clinical excellence, coding compliance, and adherence to practice protocols. They are responsible for managing regional business performance, fiscal budgets, and professional development of the clinical staff.
Provide one-on-one virtual nutrition coaching to help members achieve wellness goals through personalized care plans. Collaborate with interdisciplinary healthcare teams to deliver integrated care and document patient progress.
Lead multidisciplinary teams to develop and execute technology product strategies for clinical documentation and care delivery. Partner with clinical and business leaders to integrate technology solutions that improve patient outcomes and reduce administrative burdens.
The Lead Director will define and execute the technology product strategy for chronic condition management programs, coordinating across clinical and business domains to ensure seamless care delivery. They will lead multidisciplinary teams to translate clinical vision into scalable technology roadmaps that optimize patient outcomes and reduce medical costs.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home and virtual health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and improve overall health outcomes.
The RN Case Manager assesses, plans, and coordinates medical care for members to facilitate overall wellness through telephonic and face-to-face interactions. They utilize clinical data and judgment to develop proactive care plans, reduce risk factors, and ensure compliance with regulatory policies.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide connections to appropriate health resources.
The RN Case Manager assesses, plans, and coordinates medical care for members to facilitate overall wellness. They utilize clinical tools and data to address complex health issues and ensure compliance with regulatory policies.
You will lead a team of software and Salesforce engineers to build scalable, cloud-native solutions that support critical business areas like marketing, sales, and outreach. The role involves driving technical vision, ensuring engineering excellence through Agile practices, and integrating emerging AI capabilities into the enterprise CRM ecosystem.
The RN Case Manager assesses, plans, and coordinates medical care for members to facilitate overall wellness through telephonic and face-to-face interactions. They utilize clinical data and judgment to develop proactive care plans, reduce risk factors, and ensure compliance with regulatory policies.
The Senior Analyst will perform financial analysis and underwriting to support PBM pricing strategies and drive value for the enterprise. Responsibilities include developing pricing recommendations, managing complex pricing models, and advising internal stakeholders on contract negotiations and regulatory changes.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
The Utilization Management Nurse Consultant assesses, plans, and coordinates healthcare services for members by applying clinical criteria and guidelines. They also communicate with providers to facilitate treatment and identify opportunities to improve the quality and effectiveness of healthcare benefit utilization.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge care gaps and provide necessary health education.
The Lead Director is responsible for defining the product vision, strategy, and roadmap for Medicare claims technology platforms to improve automation, accuracy, and compliance. They will lead cross-functional teams and manage vendor relationships to ensure product performance and business outcomes are achieved.
The Case Management Coordinator collaborates with members, providers, and community organizations to facilitate appropriate healthcare outcomes for dual-eligible populations. They utilize critical thinking to assist with appointment scheduling, benefit access, and care management tools.
The Physician Reviewer is responsible for providing accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management criteria and clinical judgment. They must work collaboratively with care teams to ensure patients receive medically appropriate care in the right setting.
The Strategic Account Executive is responsible for managing multi-year account strategies, renewal outcomes, and executive relationships for large, complex pharmacy benefit manager clients. This role involves leading financial negotiations, interpreting drug trend data, and coordinating with internal teams to drive client-focused solutions.
The Medical Director provides clinical oversight and mentorship for CVS Health clinical programs, including formulary development and utilization management. They are responsible for reviewing complex clinical cases, conducting medical necessity appeals, and providing consultative support to internal departments and clients.
The Manager of Executive Resolutions oversees a team dedicated to investigating and resolving complex patient concerns and escalated service issues. This role involves designing sustainable resolution programs, managing cross-functional workflows, and coaching team members to ensure high-quality patient experiences.
The Strategic Initiatives Lead will advance the Medicare Technology strategy by managing vendor operations, AI enablement, and cross-functional initiatives. This role also oversees operating and capital expense planning while serving as a strategic advisor to leadership.
Assess members’ needs and eligibility, coordinate care plan activities, connect members with benefits and services, and refer high-risk cases to clinical case management or crisis intervention when appropriate. Collaborate with care teams to address barriers, promote member engagement and informed healthcare decisions, and document care in accordance with regulatory and company requirements.
The Case Manager conducts comprehensive assessments of member needs and develops collaborative care plans to facilitate appropriate health services. They perform crisis intervention and utilize motivational interviewing to engage members in achieving optimal health outcomes.
The manager will lead all phases of reporting projects, including business analysis, data strategy, and report development. They will also collaborate with stakeholders to interpret data trends and ensure reporting processes adhere to regulatory standards.
The Utilization Management Nurse Consultant reviews clinical information to support coverage determinations and coordinates care with providers and internal teams. They also identify opportunities to improve healthcare quality and serve as a clinical resource for benefit management questions.
The Case Management Coordinator collaborates with members, providers, and community organizations to facilitate appropriate healthcare outcomes for dual-eligible populations. They utilize critical thinking to assist with appointment scheduling, benefit access, and member education while managing complex health and social needs.
The Case Management Coordinator collaborates with members, providers, and community organizations to address complex health and social needs. They facilitate healthcare outcomes by assisting with appointment scheduling, benefit access, and member education.
Lead enterprise ServiceNow security and data protection strategy, governance, access controls, and security architecture across the platform. Oversee audits, risk assessments, monitoring and incident response, sensitive-data safeguards, identity services, and security and privacy controls for AI-enabled capabilities.
The Case Manager RN will conduct comprehensive health assessments and develop personalized care plans to help members navigate their healthcare needs. They will collaborate with multidisciplinary teams to address clinical, social, and behavioral health needs while improving overall wellness outcomes.
The Utilization Management Nurse Consultant assesses, plans, and coordinates healthcare services to ensure appropriate benefit utilization for members. They apply clinical criteria and guidelines to render coverage determinations while communicating with providers to facilitate effective care.
The Senior Coordinator supports business operations by monitoring compliance with policies, regulatory requirements, and quality standards. They manage ticketing systems, conduct audits, and lead process improvement initiatives to ensure operational efficiency and risk mitigation.
Conduct in-home health evaluations, including medication and medical history reviews, physical evaluations, and plan-ordered diagnostic and preventive services. Build trusted relationships with members, help connect them to appropriate care, communicate with primary care teams, and provide virtual visits or travel within licensed states as needed.
Conduct approximately 45-minute in-home health evaluations, including one-on-one conversations, medication and medical history reviews, and physical evaluations. Provide indicated diagnostic and preventive services, conduct virtual visits as needed, travel locally within licensed states, and help connect members with appropriate care.
Assess members’ clinical information and apply clinical criteria, policies, and judgment to make or recommend coverage determinations across the continuum of care. Coordinate with providers and other parties, identify referrals and opportunities to improve care quality and benefit utilization, and support the administration of utilization management.
The Senior Manager of AI Engineering will lead the design, development, and operationalization of enterprise-scale AI and Generative AI solutions. They are responsible for building high-performing engineering teams and establishing architectural standards to drive measurable business outcomes.
The Senior Analyst will formulate pricing strategies and execute financial modeling for complex PBM client contracts. They will also present financial analyses to executive leadership and collaborate with sales teams to achieve revenue and profitability targets.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Senior Manager will lead the transformation of pharmacy reimbursement performance evaluation and develop scalable methodologies for measuring Payer programs. They will provide analytical leadership and strategic recommendations to strengthen the company's competitive position in the marketplace.
The Care Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to children and families with complex behavioral health needs. They collaborate with multidisciplinary teams to implement care plans, monitor progress, and ensure access to necessary services.
The Care Management Coordinator evaluates member needs and implements care plans to facilitate appropriate healthcare outcomes. They serve as a single point of contact for members, collaborating with multidisciplinary teams to overcome barriers and ensure quality of care.
The manager provides strategic leadership for financial planning and analysis by coordinating budgeting, forecasting, and long-term strategic planning processes. They also conduct in-depth financial analysis to evaluate business performance and collaborate with stakeholders to drive revenue growth and cost-saving initiatives.
The Lead Solution Architect designs, builds, and maintains scalable application architecture while collaborating with stakeholders to define strategic technical visions. They also supervise architectural initiatives, mentor team members, and evaluate new technologies to drive modernization within the healthcare business unit.
The Case Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education for members using care management tools. They collaborate with Child and Family Teams to evaluate member needs, monitor care plan progress, and ensure quality of care.
The Director will lead the modernization of eligibility processing from legacy systems to a cloud-based data platform while overseeing a multi-team engineering organization. Responsibilities include managing delivery, operational stability, production support, and strategic planning for APIs and client onboarding.
The Proposals Associate provides strategic and technical support for the sales process by designing customer-centered proposals and calculating fees. They also assist with plan design reviews, prepare deviation documents, and contribute material for sales presentations.
The role involves designing Salesforce system architectures, data models, and integrations while leading the configuration and customization of the platform. You will also provide technical leadership to development teams and ensure compliance with security standards and governance policies.
The Lead Director will define and execute the technology product strategy for quality measures and Medicare Stars programs to improve clinical outcomes. They will lead multidisciplinary teams to integrate clinical vision into scalable technology roadmaps within the Epic platform.
The Senior Informatics Manager is responsible for ensuring the accuracy and integrity of clinical performance reporting and measure specifications. They will act as a liaison between business, clinical, and technology teams to drive alignment on data requirements and reporting outputs.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical examinations. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The role involves developing and maintaining QuickBase applications and clinical performance report logic to support operational measurement. You will act as the analytic lead for complex projects, ensuring data integrity and collaborating with business stakeholders to drive continuous improvement.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide connections to appropriate health resources.
The Patient Care Coordinator processes monthly patient refill requests and ensures accurate documentation for enteral nutrition orders. They also handle incoming calls from patients and providers while verifying demographics and insurance information to facilitate service admissions.
The Patient Care Coordinator is responsible for managing patient communications and coordinating care services. They will ensure administrative tasks are completed to support efficient patient flow and service delivery.
The Lead Director will oversee patient experience strategy, including managing NPS and CAHPS performance across the organization. They will lead cross-functional initiatives and serve as the primary liaison with payer partners to drive member engagement and operational improvements.
The Staff Data Engineer will design and implement a near real-time transactional cache platform to optimize data flow from UniVerse to PostgreSQL and MongoDB. This role involves leading technical architecture, mentoring engineering teams, and ensuring platform reliability and performance for API-serving data.
The Chief of Staff will act as the primary partner to the SVP of Healthcare Analytics, managing financial budgets, operational processes, and executive communications. They will also oversee talent management, strategic planning, and cross-functional coordination to ensure organizational goals are met.
Builds strategic partnerships with producers and customers to drive profitable growth and cross-sell opportunities across assigned territories. Manages the full sales cycle, including prospect development, competitive quoting, and coordinating presentations to meet revenue objectives.
The Digital Development Engineer II will improve the reliability, resilience, and performance of critical applications and infrastructure. Responsibilities include developing automation to reduce manual work, managing production incidents, and establishing SLIs and SLOs.
The role involves designing and maintaining Power BI dashboards and analytics solutions to support sales insights and business decision-making. It also requires partnering with stakeholders to translate business needs into scalable reporting assets while ensuring data reliability and governance.
The Strategic Account Executive serves as the primary relationship manager for FEP Mail Order business, ensuring client satisfaction and operational performance. They lead cross-functional teams to drive strategic initiatives, resolve complex issues, and maintain contractual compliance.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
The Staff Software Development Engineer will design, develop, and implement scalable digital health solutions while collaborating with cross-functional teams. They are also responsible for providing technical mentorship to junior developers and ensuring adherence to high-quality coding standards.
Lead and develop a multidisciplinary analytics team to transform reactive reporting into proactive, strategic decision support. Manage the analytics product portfolio by streamlining dashboards and ensuring high-quality, actionable insights for senior sales leadership.
Conduct in-home health evaluations, including medication reviews, medical history assessments, and physical examinations for health plan members. Provide diagnostic and preventive services while building trusted relationships to help bridge gaps in patient care.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care to improve health outcomes.
The manager oversees balance sheet reconciliation governance, quality assurance, and continuous improvement within the Record-to-Report organization. They also manage offshore direct reports and lead finance transformation initiatives involving systems like BlackLine and SAP S/4HANA.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Build trusted relationships with patients and coordinate with their care teams to improve overall health outcomes.
The Sr. Client Operations Analyst supports health plan partners by managing client requests, ad-hoc reporting, and data analysis. They also lead cross-functional project teams and ensure client deliverables meet service level agreements.
The manager will lead workforce intelligence and analytics initiatives to support enterprise workforce planning, talent pipeline development, and program effectiveness. They are responsible for transforming complex data into actionable business intelligence and serving as the business owner for the Workforce Initiatives data ecosystem.
The RN Case Manager is responsible for telephonically assessing, planning, and coordinating case management activities to evaluate medical needs and facilitate member wellness. They apply clinical judgment to develop proactive care plans, address risk factors, and ensure compliance with regulatory and company policies.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments for health plan members. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
Conduct in-home health evaluations, including medication reviews, medical history assessments, and physical examinations. Provide patient education and facilitate connections to appropriate care based on individual health needs.
The RN Case Manager assesses, plans, and coordinates care for members to evaluate medical needs and facilitate overall wellness. They apply clinical judgment to address complex health indicators and ensure compliance with regulatory and company policies.
The Senior Manager will develop and maintain payer-specific negotiation playbooks and frameworks to standardize deal preparation across the organization. They will also lead post-mortem reviews of negotiation outcomes to refine strategies and drive institutional knowledge transfer.
The Physician Reviewer is responsible for providing accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management criteria and clinical judgment. They must work collaboratively with care teams to ensure medically appropriate care is delivered while maintaining compliance with regulatory and accreditation requirements.
The Case Manager RN will assess member needs, develop personalized care plans, and coordinate resources to improve health outcomes. They will collaborate with multidisciplinary teams and provide support through telephonic and virtual interactions.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical examinations. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
The physician will conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They will utilize an intuitive clinical workflow to document findings and facilitate connections to appropriate care services.
The Senior Manager directs agile team activities, oversees Scrum events, and removes obstacles to ensure progress. They also develop agile governance frameworks, monitor performance metrics, and foster cross-functional collaboration to drive continuous improvement.
The Senior Coding Quality Analyst performs comprehensive medical record reviews to ensure coding compliance and identify potential billing errors or fraudulent activity. They also provide mentorship to coders and contribute to process improvements within the Special Investigations Unit.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health insights.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and improve overall health outcomes.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide health education and connect patients to appropriate care resources based on their unique needs.
The Manager Client Audit will lead and coordinate complex client-requested rebate audits from start to finish. They are responsible for serving as the primary point of contact for clients and auditors while resolving audit findings and identifying process improvements.
Conduct in-home and virtual health evaluations, including medication reviews and physical assessments for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The Case Manager RN is responsible for assessing, planning, and coordinating case management activities to evaluate and support the medical and social needs of dual-eligible members. They act as frontline advocates, developing proactive care plans to enhance member wellness and collaborating with interdisciplinary teams to overcome barriers to care.
The Senior Manager directs provider network performance and negotiates value-based contracts to improve health outcomes and cost efficiency in the Louisiana Medicaid market. They also conduct market analysis and collaborate with internal teams to align network development with strategic organizational goals.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary diagnostic and preventive services.
The Associate Manager oversees healthcare management staff to ensure high-quality clinical and non-clinical interventions for members. They are responsible for meeting financial and operational objectives while mentoring the team and ensuring compliance with regulatory standards.
The Staff Software Engineer will act as a technical lead to design and implement scalable solutions while mentoring junior developers. They will also collaborate with business leaders to resolve complex technical issues and drive delivery excellence across the platform.
The Patient Intake Coordinator manages the initial admission of patients into the Enteral Nutrition Center by processing orders and coordinating care. They act as a liaison between branch staff, sales teams, and insurance verification departments to ensure seamless service delivery.
The Senior Regulatory Analyst manages regulatory filings, responses, and communications with state regulators to ensure compliance for Aetna's commercial health insurance business. The role also supports corporate governance activities and coordinates with internal and external stakeholders to track legislative and regulatory changes.
The analyst will collaborate with HR and IT teams to configure, maintain, and optimize Workday Talent Management solutions. They are responsible for gathering business requirements, troubleshooting system issues, and developing analytics to support HR objectives.
The Case Management Coordinator evaluates member needs and eligibility to develop and implement comprehensive care plans. They utilize motivational interviewing and negotiation skills to ensure medical appropriateness and support members in achieving optimal health outcomes.
The AVP, Stars will lead the quality strategy and programs to improve HEDIS, Stars, and chronic condition management performance across Oak Street Health centers. This role involves partnering with executive and clinical leadership to implement enterprise quality initiatives and drive continuous improvement in clinical and financial outcomes.
The Contract Negotiation Manager negotiates, executes, and analyzes contracts with providers to maintain network quality and meet financial goals. They also manage provider relationships, resolve escalated issues, and support cost-saving initiatives through strategic network configurations.
The Behavioral Health Network Relations Manager acts as the primary resource for high-profile providers to maintain positive relationships and resolve complex issues regarding Medicaid policies and claims. They also educate providers on contract compliance and collaborate cross-functionally to manage cost drivers and support business objectives.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
The Network Relations Manager designs, develops, and maintains relationships with healthcare providers to ensure a strong network of care. They analyze provider performance, resolve escalated issues, and collaborate with internal teams to identify network expansion opportunities.
The Capture Director leads strategy and capture planning activities for Medicaid business development, including RFx proposal development and cross-functional team coordination. They are responsible for researching competitive landscapes, identifying win strategies, and managing intelligence to improve proposal quality and win probability.
Review treatment plans and clinical documentation to ensure medical necessity and appropriate resource utilization for behavioral health services. Collaborate with providers and care teams to facilitate optimal treatment outcomes and support quality improvement efforts.
The Senior Analyst is responsible for maintaining item-related master data across various pharmacy systems and collaborating with internal business partners to validate data requests. They also execute data reports, support capital projects, and serve as a mentor and documentation steward for the team.
The engineer will ensure the reliability, availability, and performance of GCP-based applications while implementing CI/CD pipelines and SRE best practices. They will also build and maintain infrastructure to support AI agents, LLM integrations, and secure cloud governance.
The Senior Manager of Underwriting will lead a team to manage complex PBM pricing strategies and financial analysis to support business growth. Responsibilities include coaching underwriters, developing analytic models, and consulting with internal sales and finance leadership.
The Patient Care Coordinator serves as the primary point of contact for patients and healthcare providers to manage nutrition therapy orders and account inquiries. Responsibilities include processing refills, verifying insurance documentation, and maintaining accurate electronic patient records.
The Patient Care Coordinator serves as the primary point of contact for patients and healthcare providers to manage nutrition therapy orders and account inquiries. Responsibilities include processing refill requests, verifying insurance documentation, and maintaining accurate electronic patient records.
The Manager, Client Operations serves as the primary operational contact for clients, leading matrixed teams to align success strategies with project execution. They are responsible for managing client deliverables, overseeing program implementations, and ensuring effective communication between internal stakeholders and clients.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
Leads the product strategy and lifecycle for Epic electronic health record platforms and clinical informatics tools. Collaborates with cross-functional teams to translate clinical and business needs into actionable product requirements and workflows.
Conduct in-home health evaluations to bridge gaps in care and provide comprehensive health assessments for members. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining detailed clinical documentation.
The Lead Director will oversee actuarial pricing, projections, and financial reporting for large fully-insured clients and the Medicare Part D pharmacy business. This role involves collaborating with cross-functional teams to provide strategic insights and translate complex legislative developments into actionable business strategies.
Review preauthorization requests for behavioral health services using evidence-based guidelines and clinical judgment. Coordinate and communicate utilization management decisions while managing crisis calls and assessing member risk.
The Lead Director manages high-value pharmaceutical rebate contracts, ensuring accurate realization, reconciliation, and reporting of contracted discounts. They also partner with leadership to shape negotiation strategies and resolve manufacturer disputes while maintaining strong industry relationships.
The pharmacist will provide clinical support services to long-term care pharmacies, including managing clinical claims and performing medication therapy management. They will also initiate prior authorizations and coordinate therapeutic interchange requests to optimize patient outcomes.
The Senior Product Analytics Associate will lead the development of a data-driven product roadmap by defining and tracking key product metrics. They will also design A/B tests, build data transformation models, and create Power BI dashboards to communicate product performance to stakeholders.
The clinician will review behavioral health authorization requests and clinical documentation to determine medical necessity and appropriate levels of care. They will also coordinate with providers, support discharge planning, and participate in crisis queue coverage.
The clinician will review behavioral health treatment plans to determine medical necessity and coordinate care with providers. They are also responsible for facilitating discharge planning, providing crisis intervention, and promoting cost-effective, high-quality healthcare outcomes.
The Senior Manager leads end-to-end contract negotiations and manages performance for hospital and physician group networks. They also drive the development of value-based arrangements and recruit providers to meet network expansion and adequacy targets.
The Case Management Coordinator collaborates with members, providers, and community organizations to evaluate needs and facilitate appropriate healthcare outcomes. They coordinate care plan activities, monitor progress, and use motivational interviewing to ensure member engagement and health goal achievement.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to help bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Design, build, and operate enterprise Infrastructure as Code platforms to automate provisioning, governance, and lifecycle operations across multi-cloud environments. Lead platform architecture and modernization initiatives while mentoring engineers to drive best practices in reliability, security, and developer productivity.
The Clinical Case Manager will conduct comprehensive behavioral health assessments and develop individualized care plans to address member needs. They will also perform crisis intervention, coordinate care with providers, and utilize motivational interviewing to promote sustainable behavior change.
The Senior Investigator conducts complex investigations into healthcare fraud, waste, and abuse by analyzing claims data and identifying aberrant billing patterns. They also collaborate with law enforcement and internal stakeholders to facilitate case outcomes and provide guidance to junior investigators.
The Case Management Coordinator facilitates healthcare outcomes by assisting members with appointment scheduling, benefit access, and care plan implementation. They also conduct comprehensive evaluations of member needs and collaborate with clinical teams to ensure quality of care.
The Case Management Coordinator facilitates healthcare outcomes by assisting members with appointment scheduling, benefit access, and care plan implementation. They utilize critical thinking to evaluate member needs, identify high-risk factors, and collaborate with clinical teams to ensure quality of care.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
The analyst will perform comprehensive medical record reviews to ensure coding compliance and identify potential billing errors, abuse, or fraud. They will also articulate findings to investigators, leadership, and legal counsel while researching state and federal policies.
The Transition of Care Registered Nurse manages care transitions for high-risk, medically complex members to ensure safe and effective recovery. They facilitate interdisciplinary care team meetings, perform post-discharge assessments, and coordinate necessary services to reduce hospital readmissions.
The Transition of Care Registered Nurse manages the seamless transition of high-risk members between institutional and community settings to reduce readmissions. They lead interdisciplinary care teams to develop individualized care plans and address health-related social needs.
The Case Manager coordinates and facilitates comprehensive care for members by assessing needs, developing personalized care plans, and collaborating with healthcare providers. They act as a liaison between patients, families, and medical teams to ensure effective resource utilization and positive health outcomes.
The AVP of Platform Security will define and execute the enterprise strategy for securing cloud, container, and AI platforms across the organization. This role involves leading a high-performing team to implement security standards, architecture, and controls while partnering with cross-functional leadership to ensure secure technology adoption.
Provide strategic legal counsel on the design, administration, and regulatory compliance of health, welfare, retirement, and executive compensation plans. Manage the Compensation and Benefits legal team while advising internal stakeholders and fiduciaries on governance and risk mitigation.
Provide one-on-one home infusion nursing care and patient education in accordance with the physician's plan of treatment. Maintain accurate documentation of patient care activities and participate in an on-call rotation as required.
The Lead Data Privacy Engineer will drive the strategy, design, and implementation of scalable privacy-enhancing technologies and enterprise data protection solutions. This role involves collaborating with cross-functional teams to embed privacy-by-design principles and ensure compliance with regulatory requirements across the organization.
Conducts routine care coordination, support, and education to facilitate appropriate healthcare outcomes for members. Implements projects and processes for case management while consulting with medical directors to overcome barriers to care.
The Senior Manager will lead application development projects, coordinating with vendor staff and internal teams to execute EHR use cases and system upgrades. They are responsible for defining business requirements, managing project documentation, and ensuring quality standards are met across healthcare delivery systems.
The Principal Cloud Infrastructure Engineer will lead the GCP cloud engineering team, setting architectural direction and establishing engineering standards for the enterprise. This role involves hands-on development of infrastructure as code, platform automation, and ensuring the security, scalability, and reliability of the GCP environment.
The Lead Director oversees the software product management for the Security Automation portfolio, defining strategy, roadmaps, and outcome-based success metrics. They are responsible for leading and coaching a team of product managers while partnering with engineering to ensure effective product delivery and adoption.
Coordinates case management activities with members to evaluate medical needs and facilitate overall wellness. Develops strategies to address health issues and instructs programs in compliance with clinical coverage policies.
Coordinates case management activities to evaluate medical needs and facilitate member wellness. Develops strategies to address health outcomes and instructs on programs in compliance with clinical policies.
Coordinates case management activities to evaluate medical needs and facilitate member wellness. Develops strategies to address health outcomes and instructs programs in compliance with clinical policies.
The Lead Director will oversee technology product strategy for specialty care and partnerships to optimize patient outcomes and reduce medical costs. They will lead multidisciplinary teams to integrate clinical workflows within Epic and external data sources to drive high-quality care delivery.
Coordinates case management activities with members to evaluate medical needs and facilitate overall wellness. Develops strategies to address health issues and ensures compliance with clinical coverage policies.
The Senior Epic Analyst leads the design, build, and optimization of Epic solutions for population health and care coordination workflows. This role serves as a subject matter expert, mentoring junior staff and partnering with clinical leadership to translate strategic goals into technical requirements.
The Medical Director provides oversight for medical policy implementation and manages clinical programs to address member needs. They are responsible for utilization review, quality assurance, and acting as a clinical liaison to network providers.
The Utilization Management Nurse Consultant reviews authorization requests and evaluates medical necessity using clinical records and evidence-based guidelines. They collaborate with interdisciplinary teams to facilitate quality care while ensuring compliance with health plan policies and regulatory standards.
Community Health Workers conduct home visits to support members with chronic conditions, helping them navigate the healthcare system and manage social determinants of health. They also facilitate care plan implementation, assist with medication adherence, and coordinate with community resources to improve overall health outcomes.
Community Health Workers conduct home visits to support members with chronic conditions, helping them navigate the healthcare system and adhere to care plans. They also build relationships with providers and community agencies to address social determinants of health and improve overall health outcomes.
The Case Management Coordinator collaborates with members, providers, and community organizations to address the full continuum of healthcare and social determinant needs. They facilitate appropriate healthcare outcomes by assisting with appointment scheduling and identifying benefits and resources for dual-eligible members.
The Sales Strategy Executive develops and executes cross-sell pursuit strategies to drive dental and vision membership growth within national accounts. They also manage the RFP process, coordinate sales presentations, and collaborate with internal teams to meet business targets.
Community Health Workers serve as a bridge between members and the healthcare system by conducting home visits to reinforce care plans and improve health outcomes. They also identify social determinants of health, assist with resource navigation, and maintain accurate electronic health records.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Travel to various locations within the coverage area to provide comprehensive and personalized health services.
The Peer Support Specialist provides coaching, mentoring, and recovery support to youth and young adults with lived experience in mental health or substance use. They collaborate with clinical teams to assist members in achieving recovery goals and navigating public systems like schools and juvenile justice.
Peer Support Specialists guide and mentor members by sharing lived experience to help them achieve personalized recovery goals. They collaborate with care management teams to coordinate care, conduct field-based visits, and connect members with community-based resources.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge care gaps and provide comprehensive health insights to their care teams.
The Clinical Case Manager facilitates physical and behavioral healthcare by assessing member needs and coordinating psychosocial wraparound services. They are responsible for directing provider collaboration and implementing strategies to ensure cost-effective, high-quality health outcomes.
The Clinical Case Manager facilitates physical and behavioral healthcare by assessing member needs and coordinating psychosocial wraparound services. They are responsible for directing provider collaboration and utilizing resources to achieve cost-effective, optimal health outcomes.
The role is responsible for defining portfolio strategy, designing differentiated product solutions, and driving end-to-end portfolio performance. It involves leading cross-functional alignment across a matrixed organization to ensure successful execution and delivery of business objectives.
The Case Management Coordinator facilitates healthcare outcomes by assisting members with appointment scheduling, benefit access, and care plan implementation. They utilize critical thinking to evaluate member needs, identify high-risk factors, and collaborate with multidisciplinary teams to ensure quality of care.
The Care Manager Registered Nurse facilitates healthcare outcomes by collaborating with members, providers, and community organizations to address complex health and social needs. They utilize critical thinking to manage the case management process, including appointment scheduling and benefit navigation.
The Care Manager Registered Nurse facilitates healthcare outcomes by collaborating with members, providers, and community organizations to address complex health and social needs. They utilize critical thinking to assist with appointment scheduling, benefit access, and member education through various care management tools.
The Case Management Coordinator evaluates member needs and eligibility to develop and implement effective care plans. They collaborate with healthcare teams to ensure medical appropriateness, quality of care, and optimal health outcomes for members.
The Case Management Coordinator collaborates with members, providers, and community organizations to address complex health and social needs. They facilitate healthcare outcomes by assisting with appointment scheduling, benefit access, and patient education.
The Case Management Coordinator facilitates healthcare outcomes by assisting members with appointment scheduling, benefit navigation, and care plan implementation. They utilize critical thinking to evaluate member needs, identify high-risk factors, and provide coaching to promote healthy lifestyle choices.
Community Health Workers conduct home visits to support Aetna members with chronic conditions by reinforcing care plans and improving access to healthcare services. They also educate providers on social determinants of health and assist members in navigating community resources and social services.
The Care Manager Registered Nurse collaborates with members, providers, and community organizations to address complex health and social needs. They facilitate healthcare outcomes by assisting with appointment scheduling, benefit navigation, and patient education.
The Case Management Coordinator collaborates with members, providers, and community organizations to address complex health and social determinant needs. They facilitate healthcare outcomes by assisting with appointment scheduling, benefit access, and member education using care management tools.
The Client Service Director leads an account executive team to drive customer satisfaction, retention, and profitable growth within an assigned book of business. They are responsible for overseeing team performance, executing growth strategies, and ensuring consistent service delivery through effective staff training and resource allocation.
The Care Manager Registered Nurse collaborates with members, providers, and community organizations to address complex health and social determinant needs. They facilitate healthcare outcomes by assisting with appointment scheduling, benefit access, and patient education using clinical care management tools.
The analyst conducts comprehensive assessments and provides routine care coordination to support members in achieving optimal health outcomes. They collaborate with healthcare providers and community partners to address barriers to care and facilitate access to necessary services.
The analyst conducts routine care coordination, assessments, and education to help members navigate healthcare services and achieve optimal health outcomes. They collaborate with interdisciplinary teams and community partners to address barriers to care and empower members in their healthcare decision-making.
The analyst conducts routine care coordination, assessments, and education to help members navigate healthcare resources and achieve optimal health outcomes. They collaborate with interdisciplinary teams and healthcare providers to address member needs while maintaining accurate and compliant documentation.
The engineer will design, code, test, and debug software applications for the CVS Application Platform (CAP) to support digital health experiences. They will also collaborate with cross-functional teams to implement features, perform testing, and participate in on-call rotations.
The Case Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to children with complex behavioral health needs. They collaborate with Child and Family Teams to monitor care plans and ensure appropriate service delivery.
The Case Management Coordinator facilitates healthcare outcomes by assisting members with appointment scheduling, benefit navigation, and care plan implementation. They also collaborate with clinical teams to identify high-risk factors and ensure quality of care through ongoing monitoring and documentation.
The Analyst conducts routine care coordination, assessments, and education to help members navigate healthcare resources and achieve optimal health outcomes. They collaborate with interdisciplinary teams and healthcare providers to address barriers to care while maintaining accurate documentation and compliance standards.
The coordinator facilitates healthcare outcomes by providing care coordination, support, and education to members using case management tools. They collaborate with child and family teams to evaluate needs, implement care plans, and monitor progress while ensuring compliance with regulatory guidelines.
The Case Manager facilitates healthcare outcomes by collaborating with members, providers, and community organizations to address complex health and social needs. They utilize critical thinking to assist with appointment scheduling, benefit access, and member education through established care management tools.
The Case Management Coordinator evaluates member needs and eligibility to recommend appropriate care resolutions and service plans. They facilitate healthcare outcomes by coordinating care activities, monitoring progress, and providing coaching to empower members in their healthcare decision-making.
The Case Management Coordinator collaborates with members, providers, and community organizations to address health and social determinant needs. They facilitate healthcare outcomes by assisting with appointment scheduling, benefit access, and member education.
The pharmacist provides one-on-one medication therapy management consultations via phone or video to identify and resolve medication-related problems. They collaborate with multidisciplinary teams to develop personal care plans and monitor patient drug therapy outcomes.
The Care Plan Reviewer utilizes clinical judgment to review assessments and care plans to support behavioral healthcare for children with complex needs. They provide coaching to care coordination staff and consult with multidisciplinary teams to ensure optimal, cost-effective outcomes.
The Care Plan Reviewer facilitates physical and behavioral healthcare through comprehensive assessments, care planning, and direct provider coordination. They perform crisis intervention, monitor care plans, and utilize clinical judgment to ensure optimal, cost-effective health outcomes for members.
Provide one-on-one virtual nutrition coaching to help members achieve wellness goals through personalized care plans and behavior change strategies. Collaborate with interdisciplinary healthcare teams to deliver integrated care and document all coaching sessions and outcomes.
The Care Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to members using established care management tools. They collaborate with Child and Family Teams to evaluate member needs, implement care plans, and monitor progress while ensuring compliance with regulatory guidelines.
The Care Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to children and families with complex behavioral health needs. They conduct comprehensive evaluations, implement care plans, and serve as a single point of contact to remediate gaps in care.
The Case Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to children with complex behavioral health needs. They collaborate with Child and Family Teams to evaluate member needs, monitor care plans, and ensure access to necessary services.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge care gaps and provide health education in their own homes.
The Case Manager acts as a liaison to coordinate care for dual-eligible members, performing assessments and developing care plans to optimize health outcomes. They conduct home and worksite visits to facilitate benefit eligibility, wellness activities, and timely return-to-work strategies.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and facilitate connections to appropriate care to improve health outcomes.
The Case Management Coordinator collaborates on the case management process by evaluating member needs, coordinating care plans, and facilitating healthcare outcomes. They utilize negotiation and motivational interviewing skills to engage members and ensure appropriate access to benefits and services.
The Care Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to members using care management tools. They collaborate with Child and Family Teams to monitor care plans and ensure appropriate service delivery for children with complex behavioral health needs.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
The Clinician Field Mentor conducts in-home evaluations for patients while providing mentorship and guidance to new and active clinicians. They also serve as an early adopter for new clinical workflows and diagnostic services to ensure high-quality care standards.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
Conduct comprehensive in-home health evaluations for health plan members, including physical exams and medication reviews. Facilitate connections to appropriate care and document findings using an intuitive clinical workflow on an iPad.
The physician will conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. The role involves traveling to various locations to provide comprehensive health services and build trusted relationships with patients.
Conduct in-home health evaluations for patients to bridge gaps in care and provide comprehensive health assessments. Engage with patients to review medical history, perform physical evaluations, and facilitate necessary diagnostic tests.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care. Perform medication reviews, physical assessments, and diagnostic tests while building trusted relationships with patients.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide comprehensive health assessments. Utilize clinical workflows to perform medication reviews, physical evaluations, and diagnostic tests while building trusted relationships with patients.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Travel extensively to provide comprehensive health services and bridge gaps in care for patients.
The physician will conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They will travel extensively to provide these services and document findings using an intuitive clinical workflow on an iPad.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Travel extensively within the assigned coverage area to provide comprehensive health services and bridge gaps in care.
Conduct in-home health evaluations for patients to bridge gaps in care and provide comprehensive health assessments. Engage with patients to review medical history, perform physical evaluations, and facilitate connections to appropriate care services.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care and improve health outcomes. Perform medication reviews, physical assessments, and diagnostic screenings while maintaining detailed clinical documentation.
The physician will conduct in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. They are responsible for traveling to various locations to provide comprehensive health assessments while maintaining accurate clinical documentation.
Conduct in-home health evaluations for patients to bridge gaps in care and provide comprehensive health assessments. Engage with patients to review medical history, perform physical evaluations, and facilitate connections to appropriate care services.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide patient education and bridge gaps in care while traveling across a defined coverage area.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care and improve health outcomes. Perform medication reviews, physical assessments, and diagnostic tests while maintaining detailed clinical documentation.
Conduct in-home health evaluations for patients to bridge gaps in care and provide comprehensive health assessments. Utilize clinical workflows to review medical history, perform physical evaluations, and facilitate diagnostic services.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide personalized health assessments. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining detailed clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge care gaps and provide personalized health insights.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Case Manager conducts face-to-face home visits to assess medical needs and develop comprehensive care plans for members in MLTSS and D-SNP programs. They collaborate with interdisciplinary teams and providers to ensure cost-effective service delivery and safe transitions of care.
Conduct in-home assessments for members with complex needs and develop individualized care plans to support their health and safety. Collaborate with interdisciplinary teams and providers to ensure coordinated, holistic care and document all activities in the electronic health record.
The Registered Nurse Case Manager will conduct face-to-face home visits to assess member needs and develop individualized care plans for MLTSS and D-SNP programs. They will collaborate with interdisciplinary teams and providers to ensure effective resource utilization and safe transitions of care.
Conduct in-home assessments for members with complex needs and develop individualized care plans to promote safety and independence. Collaborate with interdisciplinary teams and providers to ensure coordinated, holistic care while documenting activities in the electronic health record.
The Case Manager conducts face-to-face home visits to assess medical needs and develop comprehensive care plans for members in MLTSS and D-SNP programs. They collaborate with care teams and providers to ensure cost-effective service delivery and advocate for the member's overall wellness and safe discharge.
The Cardiopulmonary Educator will provide clinical support and infusion training to patients with Pulmonary Arterial Hypertension in their homes. They will collaborate with physicians and pharmacy operations to coordinate patient care plans while maintaining high standards of safety and quality.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide personalized health assessments. Utilize clinical workflows and diagnostic tools to review medical history and medication while maintaining detailed patient records.
The clinician will conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They are responsible for traveling to various locations to provide comprehensive health services while maintaining accurate clinical documentation.
The clinician will conduct in-home health evaluations, including physical assessments and medication reviews, to bridge gaps in patient care. They are responsible for traveling to various locations to provide personalized health services while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide diagnostic and preventive services while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while traveling to various locations within the assigned coverage area.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The Lead Director will develop and execute state-specific Medicaid strategies to drive business growth and align with healthcare policy. This role involves building relationships with key stakeholders and representing the organization at conferences and legislative meetings.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide diagnostic and preventive services while maintaining accurate clinical documentation via an iPad.
Perform in-home health evaluations for health plan members, including medication reviews and physical assessments. Engage with patients to bridge gaps in care and provide connections to appropriate health resources.
The manager oversees compliance with state Medicaid contractual requirements and leads the development of value-based provider networks. They are responsible for negotiating payment arrangements, managing contract performance, and deploying strategic initiatives to meet cost and quality goals.
You will lead and oversee external coding vendor operations to ensure contractual obligations, quality performance, and accurate ICD-10/HCC coding deliverables are met. Additionally, you will serve as the primary operational liaison between vendor leadership and internal teams to drive volume planning and regulatory compliance.
The Manager of Provider Services leads provider recruiting efforts for a division, including managing direct reports and developing regional recruiting strategies. They collaborate with leadership to forecast supply and demand while overseeing multi-channel marketing and provider engagement initiatives.
The Cardiopulmonary Patient Educator provides infusion training and clinical support to patients with Pulmonary Arterial Hypertension in a home care setting. They collaborate with physicians and pharmacy operations to coordinate patient care plans and develop one-on-one relationships with patients and caregivers.
The Senior Analyst will evaluate IT application controls and assess the design and operating effectiveness of SOX compliance across the enterprise. This role involves executing audit testing, documenting work papers, and collaborating with cross-functional teams to improve financial compliance processes.
The Stop Loss Claims Analyst manages the filing, tracking, and reconciliation of stop loss claims for self-funded employer groups. They act as a liaison between internal teams and external carriers to ensure accurate and timely reimbursement.
The Case Manager conducts face-to-face home visits to assess member medical needs and develops comprehensive care plans to facilitate wellness. They collaborate with care teams and providers to authorize services cost-effectively while ensuring safe discharge and proper resource utilization.
The Registered Nurse Case Manager will conduct in-home assessments and coordinate individualized care plans for members in managed long-term services and support programs. They will collaborate with interdisciplinary teams and caregivers to ensure high-quality, cost-effective care and safe transitions for patients.
Design network models, plan initiatives, and negotiate Commercial and Medicare Advantage agreements with Texas providers, including health systems, clinically integrated networks, IPAs, and FQHCs. Coordinate across functions to strengthen provider networks and meet accessibility, quality, compliance, regulatory, financial, and medical-cost goals.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide personalized health assessments. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical examinations. Provide diagnostic and preventive services while building trusted relationships to help bridge gaps in patient care.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide health education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Facilitate connections to appropriate care and document findings using an intuitive clinical workflow on an iPad.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments for health plan members. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
Conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Engage with patients to provide personalized health insights and facilitate connections to appropriate care services.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide health education and facilitate connections to appropriate care services based on individual patient needs.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for patients, including medication reviews and physical assessments. Facilitate connections to appropriate care and ensure health plans are informed of the patient's overall quality of life.
Develops and implements sales strategies to secure new large group accounts and government programs within an assigned territory. Manages complex negotiations, oversees the sales process, and collaborates cross-functionally to ensure successful product integration and revenue growth.
The Principal Software Development Engineer will lead the architecture, design, and delivery of scalable digital healthcare solutions leveraging AI across major cloud platforms. This role involves defining technical strategy, mentoring engineering teams, and ensuring the development of secure, high-performance applications.
The Case Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to members through comprehensive care management tools. They collaborate with multidisciplinary teams and families to evaluate needs, implement care plans, and ensure compliance with regulatory guidelines.
The Service Advocate manages patient appointments by handling inbound and outbound calls while ensuring an unmatched patient experience. They are responsible for accurate data entry, resolving scheduling conflicts, and maintaining detailed records of patient interactions.
The Lead Director will oversee the strategy, architecture, and delivery of enterprise AI platform capabilities and reusable data products. This role involves leading high-performing engineering teams to scale AI/ML solutions while establishing operational standards for governance, security, and platform reliability.
The Senior Director leads a team of Account Executives to drive customer retention, profitable growth, and client satisfaction for complex National Accounts. They coordinate cross-functional enterprise teams to manage business risks, execute account strategies, and deliver measurable value to clients.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide education and bridge gaps in care while maintaining accurate clinical documentation using provided technology.
The Service Advocate manages comprehensive patient care by handling inbound and outbound calls to schedule, reschedule, and cancel appointments. They are responsible for maintaining accurate patient records and ensuring an unmatched experience through professional communication and problem resolution.
The Senior Medical Director will lead clinical informatics and healthcare delivery technology products, serving as a physician advisor to drive Epic-enabled solutions and enterprise governance. They are responsible for optimizing clinical workflows, improving patient outcomes, and partnering with leadership to align technology roadmaps with organizational strategy.
Conduct comprehensive in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. Provide health education and facilitate connections to appropriate care services based on individual patient needs.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care to improve overall health outcomes.
Co-lead daily outreach call center operations, monitor agent performance against KPIs, and provide coaching, feedback, and action plans to improve results and ensure adherence to policies and schedules. Manage real-time productivity, queues, escalations, and team meetings while supporting hiring, training coordination, and continuous improvement.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Engage with patients to bridge gaps in care and provide education to improve health outcomes.
Conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The Senior Manager will lead engineering teams in designing and delivering scalable, cloud-native, and AI-enabled solutions for the Health100 platform. They are responsible for architectural leadership, talent development, and ensuring operational excellence through secure and compliant technology practices.
You will lead the product vision and strategic delivery for the Documents Domain within the Epic EHR platform. This involves collaborating with engineering and business stakeholders to manage product roadmaps, document ingestion pipelines, and user experience enhancements.
Lead product strategy and roadmap development for the Epic EHR platform and integrated clinical informatics tools within the Revenue Cycle Management domain. Collaborate with cross-functional teams including engineering, data science, and design to drive product adoption, quality, and safety across the enterprise.
Lead the architecture, development, and operation of Lumina, CVS Health’s enterprise agentic AI platform, including its agents, retrieval systems, integrations, services, and user experiences. Guide platform reliability, security, governance, and engineering practices while coaching engineers and data scientists and partnering with product, security, compliance, and engineering teams.
Lead Quality Engineering strategy and software delivery transformation for the Medicare Sales & Acquisition ecosystem, including AI-augmented and agent-orchestrated testing, AWS-native infrastructure, and automated SDLC pipelines. Manage and develop an SDET team, establish governance and quality metrics, and partner with business and technology stakeholders to deliver scalable, compliant automation solutions.
Lead Quality Engineering strategy and software delivery transformation for the Medicare Sales & Acquisition ecosystem, including AI-augmented and agent-orchestrated testing, AWS-native infrastructure, and automated SDLC pipelines. Manage and develop an SDET team, establish quality standards and metrics, and partner with business and technology stakeholders to deliver scalable, compliant automation.
The Staff Data Engineer will design, build, and operate scalable Databricks-based data pipelines and lakehouse solutions for observability and security data. They will collaborate with cross-functional engineering teams to establish data quality standards, governance, and operational reliability.
The Pharmacy Technician acts as a liaison between patients, providers, and pharmacists to manage medication refills and renewals. They are responsible for handling high-volume inbound and outbound calls, documenting patient requests, and coordinating with care teams to resolve barriers to medication access.
Conduct in-home assessments for members with complex needs to evaluate their medical, behavioral, and social requirements. Develop and manage individualized care plans while collaborating with interdisciplinary teams to ensure holistic and coordinated care.
The Provider Network Relationship Manager assesses network composition and manages partnerships to advance the OhioRISE program. They are responsible for executing contracts, resolving escalated issues, and driving provider engagement to meet network adequacy and quality goals.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge care gaps and provide education on their health needs.
Lead and shape enterprise-wide technical architecture initiatives while driving strategic technology direction across multiple portfolios. Serve as a trusted technical advisor to senior executives to translate complex architectural decisions into clear business outcomes.
The Contract Negotiation Manager serves as a subject matter expert responsible for negotiating, executing, and auditing complex provider contracts to meet network quality and financial goals. They collaborate cross-functionally to manage provider relationships, resolve disputes, and implement strategic network configurations.
Conduct comprehensive in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. Provide patient education and diagnostic services while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct comprehensive in-home health evaluations, including medication reviews, medical history assessments, and physical examinations. Provide patient education and bridge gaps in care to improve health outcomes for members.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide health education.
Conduct in-home and virtual health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home and virtual health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide comprehensive health education.
The Senior Manager leads end-to-end contract negotiations and manages performance for hospital and physician group networks. They also drive the development of value-based arrangements and analyze financial data to meet network expansion and cost-saving goals.
The Senior Data Engineer will design, build, and operate scalable Databricks-based data pipelines and lakehouse solutions for observability and security data. They will collaborate with cross-functional engineering teams to establish data quality standards, governance, and operational reliability.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Case Manager is responsible for conducting comprehensive in-home assessments and developing person-centered care plans for dual-eligible Medicare and Medicaid members. They coordinate services across interdisciplinary teams to ensure members receive appropriate community-based support while maintaining regulatory compliance.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and facilitate connections to appropriate care to improve health outcomes.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Engage with health plan members to provide education and facilitate connections to appropriate healthcare services.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and facilitate connections to appropriate care services based on individual health needs.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Facilitate connections to appropriate care and provide health education to improve patient outcomes.
Conduct in-home health evaluations including medication reviews, medical history assessments, and physical evaluations for health plan members. Provide patient education and diagnostic services while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide health education.
The Cardiopulmonary Patient Educator will provide clinical support and education to patients initiating complex pulmonary arterial hypertension therapies. They will collaborate with physicians and pharmacy operations to coordinate care plans while conducting both virtual and in-person patient visits.
The Cardiopulmonary Patient Educator will provide clinical support and education to patients initiating complex pulmonary arterial hypertension therapies. This role involves coordinating care plans with physicians and pharmacy operations while conducting both remote and in-person patient visits.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations including physical assessments, medication reviews, and diagnostic tests for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The Staff Engineer will lead DevSecOps implementation, migration, and automation initiatives across the Health 100 portfolio to strengthen security and release readiness. This role involves designing secure CI/CD workflows, managing security tool migrations, and driving vulnerability remediation through scalable engineering solutions.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide virtual visits as needed and facilitate connections to appropriate care based on individual health needs.
The analyst supports the build, maintenance, and optimization of Epic-based tools to improve Medicare Star Ratings and HEDIS quality measure performance. They are responsible for data validation, reporting, and collaborating with clinical stakeholders to ensure accurate care gap identification.
The Solution Architect is responsible for designing and optimizing Epic-based solutions to support Medicare Star Ratings, HEDIS, and NCQA quality measures. This role bridges clinical quality strategy with technical build requirements to ensure accurate data capture and reporting across the organization.
The role serves as a principal utilization management reviewer for Applied Behavior Analysis and psychological testing cases. It also involves providing clinical guidance to authorization teams and contributing to the development of medical management programs for neurodevelopmental disorders.
The manager will analyze, build, and maintain financial and operational tools to support network value and underwriting modeling. They will also develop data outputs, dashboards, and financial models to assist leadership in strategic decision-making.
The Contract Negotiation Manager leads end-to-end contract negotiations and manages provider relationships to enhance network access, quality, and cost efficiency. They also develop value-based contracting strategies and analyze financial data to support organizational business goals.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Facilitate connections to appropriate care and maintain accurate clinical documentation using an iPad-based workflow.
The Principal Data Scientist will lead the Excalibur team in designing, deploying, and monitoring enterprise-scale machine learning models and generative AI solutions. They will also architect scalable data pipelines on Databricks while mentoring a team of data scientists and engineers to drive operational excellence.
The Sales Executive builds strategic partnerships with brokers and customers to drive profitable growth for Aetna's dental and vision products in the small to midsize business segment. They are responsible for managing producer relations, delivering presentations, and collaborating with internal teams to ensure successful sales and client retention.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Case Manager conducts face-to-face home visits to assess member medical needs and develop comprehensive care plans for MLTSS and D-SNP programs. They collaborate with care teams and providers to authorize services and ensure safe, cost-effective care delivery.
The Case Management Analyst facilitates healthcare outcomes for LTSS members by conducting comprehensive evaluations and coordinating care plans. They provide ongoing support, education, and coaching to members while monitoring progress and ensuring compliance with regulatory guidelines.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The Senior Manager of Customer Insights will lead the strategy and execution of integrated CRM programs to drive patient acquisition, engagement, and retention. This role involves managing a team of campaign strategists and collaborating with cross-functional partners to optimize omnichannel marketing initiatives.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
The Senior Product Manager will lead the development and expansion of Fraud, Waste, and Abuse (FWA) products to drive significant annual business impact. They will oversee product strategy, manage cross-functional squads, and integrate AI/ML capabilities to enhance performance and scalability.
The Medicaid Specialist manages incoming and outgoing calls to assist patients with Medicaid redetermination, eligibility, and application processes. They also serve as an internal resource for Medicaid-related questions and advocate for patient access to healthcare resources.
The role involves maintaining and enhancing Anaplan models while translating business processes into functional and technical requirements. You will collaborate with IT and finance stakeholders to drive automation, ensure governance standards, and track measurable results using KPIs.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
The Field Social Worker conducts in-person assessments and develops member-centered care plans for dual eligible populations. They collaborate with healthcare providers and community resources to address social determinants of health and ensure effective care coordination.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical examinations. Provide patient education and facilitate connections to appropriate care while maintaining accurate clinical documentation via an iPad.
Conduct in-home and virtual health evaluations to bridge gaps in care and provide personalized health assessments. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining detailed clinical documentation.
Conduct in-home health evaluations to bridge gaps in care and provide comprehensive health assessments for plan members. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining trusted relationships with patients.
The manager will negotiate competitive contracts with behavioral healthcare providers and manage contract performance to meet financial targets. They will also build strong provider relationships and support the implementation of value-based care initiatives.
The Cardiopulmonary Patient Educator will provide clinical support and infusion training to patients with Pulmonary Arterial Hypertension in their homes. They will collaborate with physicians and pharmacy operations to coordinate comprehensive care plans for patients.
The Cardiopulmonary Patient Educator will provide clinical support and infusion training to patients with Pulmonary Arterial Hypertension in a home care setting. They will collaborate with physicians and pharmacy operations to coordinate comprehensive care plans for patients and their caregivers.
The Case Manager conducts face-to-face home visits to assess member medical needs and develops comprehensive care plans to facilitate wellness. They collaborate with care teams and providers to authorize services in a cost-effective manner while ensuring safe and appropriate care delivery.
The Case Manager conducts face-to-face home visits to assess medical needs and develop comprehensive care plans for members in MLTSS and D-SNP programs. They collaborate with care teams and providers to ensure cost-effective service delivery and accurate documentation in electronic health records.
The Senior Investigator conducts complex investigations into healthcare fraud, waste, and abuse, including managing sensitive, high-profile cases and coordinating with law enforcement. They also perform data mining to identify aberrant billing patterns, facilitate financial recoveries, and provide training to less experienced staff.
The Lead Director will establish and lead the enterprise-wide AI FinOps capability, defining the strategy, governance, and financial frameworks for AI investments. They will partner with cross-functional teams to provide transparency into AI spending and ensure value realization across the organization.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide health education in a home-based setting.
Conduct in-home health evaluations, including physical assessments, medication reviews, and medical history documentation for health plan members. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide patient education and document findings using an intuitive clinical workflow on an iPad.
The Lead Director will oversee complex engineering delivery roadmaps and AI-enabled transformations for retail front store modernization. This role involves managing cross-functional teams, tracking KPIs, and building strong relationships with business and technology partners.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Build trusted relationships with patients to bridge care gaps and provide personalized health insights.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide health education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
Lead technical initiatives to design, build, and maintain business-critical, enterprise-grade distributed systems. Collaborate across teams to drive long-term improvements in scalability, performance, and maintainability.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Provide patient education and bridge gaps in care to improve health outcomes while maintaining accurate clinical documentation.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Senior Sales Executive builds strategic partnerships to achieve profitable growth and cross-sell objectives for assigned business segments. They manage producer relations, deliver polished presentations, and collaborate with internal teams to ensure product and pricing solutions meet client needs.
Conduct in-home and virtual health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with health plan members to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation using provided digital tools.
Conduct comprehensive in-home health evaluations, including physical assessments and medication reviews, to bridge gaps in patient care. Provide patient education and facilitate connections to appropriate healthcare services while maintaining accurate clinical documentation.
The Case Management Coordinator evaluates member needs and implements care plans to facilitate appropriate healthcare outcomes for children with complex behavioral health needs. They serve as a single point of contact, collaborating with families and providers to secure necessary services and monitor progress.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Build trusted relationships with patients while providing personalized health education and diagnostic services in their homes.
The Principal Cloud Architect defines the technical direction for cloud workloads, establishing reference architectures and paved-road patterns for engineering teams. They serve as the primary technical authority for cloud design, ensuring security, resilience, and cost-efficiency across the organization.
The Principal AI Architect defines the technical direction, reference architectures, and governance for AI capabilities across Aetna Technology. This role establishes paved-road patterns for model and agent development while driving outcomes through technical influence and design authority.
The Principal Data Architect is responsible for defining the data architecture, strategy, and reference designs across a multivendor, multicloud environment. They will establish data governance, quality standards, and enable AI and analytics capabilities through robust data infrastructure.
The analyst conducts routine care coordination, support, and education to facilitate appropriate healthcare outcomes for members. They also implement case management programs and consult with multidisciplinary teams to overcome barriers to member health goals.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic screenings. Facilitate connections to appropriate care and maintain accurate clinical documentation using provided digital tools.
Conduct in-home health evaluations, including medication reviews, medical history assessments, and physical examinations for health plan members. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments for health plan members. Build trusted relationships with patients to bridge care gaps and provide necessary health education.
Conduct in-home and virtual health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Build trusted relationships with health plan members to provide personalized health education and support.
The specialist serves as the enterprise subject matter expert for Hardware Asset Management, driving lifecycle governance and ServiceNow HAM Pro optimization. They are responsible for ensuring data integrity, audit readiness, and cross-functional collaboration with procurement, finance, and IT teams.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Facilitate connections to appropriate care and maintain detailed clinical documentation using an iPad-based workflow.
Conduct in-home health evaluations for members, including medication reviews, physical assessments, and diagnostic screenings. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations for members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide comprehensive health education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and diagnostic services while maintaining accurate clinical documentation via an iPad.
The Territory Sales Executive drives specialty pharmacy sales growth by promoting services to healthcare providers and medical institutions. They are responsible for developing strategic business plans, managing customer relationships, and collaborating with internal clinical partners to achieve sales goals.
The Distinguished Engineer serves as the senior technical leader for Application Security, defining the architectural strategy for securing software across web, mobile, and AI-native environments. They are responsible for integrating security controls into CI/CD pipelines and leading the enterprise adoption of AI-assisted development guardrails.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Staff Software Development Engineer will act as a technical lead and individual contributor to design scalable solutions and build next-generation health platforms. They will also mentor junior engineers, drive delivery excellence, and collaborate with business leaders to enhance digital system performance.
Conduct comprehensive in-home health evaluations for patients, including medication reviews and physical assessments. Facilitate connections to appropriate care and ensure health plans are informed of the patient's home environment and overall quality of life.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Provide in-home health care services to patients within the designated region. Ensure high-quality, compassionate, and convenient health experiences for individuals and families.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations, including physical exams, medication reviews, and diagnostic tests for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Provide high-quality in-home health care services to patients as a Nurse Practitioner or Physician Assistant. Ensure a connected and compassionate health experience while maintaining safety and quality standards.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide patient education and bridge gaps in care while traveling across a defined coverage area.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Build trusted relationships with patients to bridge gaps in care and provide education to improve health outcomes.
Conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic tests for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and build trusted relationships to help bridge gaps in care and improve health outcomes.
Conduct in-home health evaluations, including physical assessments, medication reviews, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Engage with patients to provide health education and facilitate connections to appropriate care services.
Conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic tests for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Provide in-home clinical care to patients to ensure a connected and compassionate health experience. Collaborate with a team to simplify health care for individuals, families, and communities.
The physician will conduct in-home health evaluations, including physical exams, medication reviews, and diagnostic tests to bridge gaps in patient care. They are responsible for building trusted relationships with patients and providing comprehensive health assessments while traveling within a defined coverage area.
Conduct in-home health evaluations including medication reviews, medical history assessments, and physical examinations for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The clinician will conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic tests for health plan members. They will also provide patient education and facilitate connections to appropriate care to improve overall health outcomes.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Engage with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and bridge gaps in care while traveling across a defined coverage area.
Conduct in-home health evaluations for patients, including physical assessments and medication reviews. Provide connections to appropriate care and document findings using an intuitive clinical workflow on an iPad.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Engage with patients to bridge gaps in care and provide education to improve health outcomes.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Engage with patients to bridge gaps in care and provide education to improve health outcomes.
Conduct in-home health evaluations for health plan members, including physical assessments, medication reviews, and diagnostic testing. Build trusted relationships with patients to bridge care gaps and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Engage with patients to bridge gaps in care and provide personalized health education.
The therapist will provide psychosocial support, education, and evidence-based counseling to patients aged 13 and older. They are responsible for conducting assessments, developing treatment plans, and collaborating with the clinical care team to ensure continuity of care.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care and improve health outcomes. Perform medication reviews, physical assessments, and diagnostic screenings while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while traveling to various locations within the coverage area.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
Conduct in-home health evaluations to bridge gaps in care and provide comprehensive health assessments for patients. Engage with individuals to review medical history, perform physical evaluations, and facilitate connections to appropriate care services.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide diagnostic and preventive services while maintaining accurate clinical documentation using an iPad.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care. Perform medication reviews, physical assessments, and diagnostic screenings while maintaining accurate clinical documentation.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health insights.
The physician will conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They are responsible for traveling to various locations to provide comprehensive health services while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Travel extensively within a defined coverage area to provide comprehensive and personalized health services.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide health education and diagnostic services while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide personalized health assessments. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide personalized health insights.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care and improve health outcomes. Perform medication reviews, physical assessments, and diagnostic screenings while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide comprehensive health assessments. Utilize clinical workflows to review medical history, perform physical evaluations, and facilitate diagnostic services while building trusted relationships with patients.
The physician will conduct in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. They will travel extensively to provide these services and ensure comprehensive health assessments are delivered in a compassionate manner.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care. Perform physical assessments, medication reviews, and diagnostic screenings while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Engage with patients to bridge gaps in care and provide education on their health needs.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide connections to appropriate health services.
Conduct in-home health evaluations for patients to bridge gaps in care and provide comprehensive health assessments. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining detailed clinical documentation.
Conduct comprehensive in-home health evaluations for health plan members to bridge gaps in care. Perform medication reviews, physical assessments, and diagnostic screenings while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members to bridge gaps in care and provide personalized health assessments. Perform medication reviews, physical evaluations, and diagnostic tests while maintaining detailed clinical documentation using an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations to bridge gaps in care and build trusted relationships with patients. Perform medication reviews, physical assessments, and diagnostic screenings while documenting findings through an intuitive clinical workflow.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct in-home and virtual health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide health education.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations for members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The Medical Director provides clinical expertise to support medical policy, payment policy, and transactional reviews including appeals and claim assessments. They also serve as a subject matter expert to identify quality improvement opportunities and ensure alignment with clinical coding practices.
Conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic tests for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Provide psychosocial support and evidence-based mental health therapy to individuals, couples, and families aged 13 and older. Collaborate with clinical care teams to develop treatment plans and ensure continuity of care for patients.
The Care Management Coordinator facilitates healthcare outcomes by providing care coordination, support, and education to members using case management tools. They collaborate with Child and Family Teams to evaluate member needs, implement care plans, and ensure quality of care across child-serving systems.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home and virtual health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Build trusted relationships with patients while providing comprehensive health insights to their care teams.
The Decision Scientist will activate clinical data repositories by building feature stores, documentation, and reusable data assets to support analytics and AI products. They will act as a bridge between clinical data assets and stakeholders, ensuring data is well-documented, compliant with regulatory standards, and fit for purpose.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and improve overall health outcomes.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
The Senior Advisor serves as a subject matter expert on regulatory guidance to ensure the Pharmacy Network division maintains compliance with emerging requirements. They partner with functional leaders to translate these regulations into operational processes and proactively identify and escalate business risks.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge care gaps and provide health education in a home-based setting.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
The manager will negotiate, execute, and analyze contracts with local and small group providers to maintain network quality and financial goals. They will also collaborate cross-functionally to manage provider relationships and resolve escalated issues related to claims and contract interpretation.
Conduct comprehensive in-home health evaluations for patients, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and improve overall health outcomes.
The clinician will conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They will also perform virtual visits and provide health education to help patients manage their unique health needs.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to help bridge gaps in care and improve overall health outcomes.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide health education in a home-based setting.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Engage with patients to answer health questions and provide diagnostic services while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations for patients, including medication reviews and physical assessments. Facilitate connections to appropriate care and maintain accurate clinical documentation using provided digital tools.
Provide high-quality clinical care to patients in their homes as a Nurse Practitioner or Physician Assistant. Conduct comprehensive health assessments and manage patient treatment plans effectively.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge care gaps and provide comprehensive health insights to their care teams.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care to improve overall health outcomes.
Conduct in-home and virtual health evaluations, including medication reviews, medical history assessments, and physical examinations. Provide patient education and bridge gaps in care to improve health outcomes for health plan members.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide health education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide personalized health guidance.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide health education.
Develop and implement sales strategies to acquire new large group accounts and government programs while managing complex negotiations. Collaborate cross-functionally to integrate client needs with product offerings to drive revenue growth and support renewals.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Build trusted relationships with patients to bridge care gaps and provide health education in a flexible, clinical setting.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical exams, and diagnostic tests. Build trusted relationships with patients to bridge gaps in care and improve overall health outcomes.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical examinations. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide diagnostic and preventive services while building trusted relationships to bridge gaps in patient care.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to help bridge gaps in care and improve health outcomes.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct comprehensive in-home health evaluations for health plan members, including physical assessments and medication reviews. Provide health education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations, including physical exams and medication reviews, to bridge gaps in patient care. Provide patient education and diagnostic services while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations including medication reviews, medical history assessments, and physical examinations for health plan members. Provide patient education and diagnostic services while maintaining accurate clinical documentation using an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, medical history assessments, and physical evaluations. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Utilize clinical workflows to document findings and provide diagnostic services while building trusted relationships with health plan members.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Engage with patients one-on-one to answer health questions and provide connections to appropriate care services.
Conduct in-home and virtual health evaluations, including medication reviews and physical assessments for health plan members. Build trusted relationships with patients to bridge gaps in care and improve overall health outcomes.
Conduct comprehensive in-home health evaluations for health plan members, including physical assessments and medical history reviews. Facilitate connections to appropriate care and ensure accurate documentation using clinical workflows.
The Principal Engineer will lead the architecture, strategy, and governance of a unified, multi-cloud data ingestion platform and federated data lake. They will drive enterprise-wide technical standards, infrastructure automation, and cost-optimization initiatives to support observability, security, and AI/ML workloads.
The Account Executive serves as the primary relationship manager for mid-market and coalition pharmacy benefit manager clients, overseeing renewals, financial performance, and service delivery. They collaborate with internal teams to orchestrate cross-functional delivery while maintaining client satisfaction and retention.
The clinician will conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. They are responsible for building trusted relationships and bridging gaps in care while traveling across a defined coverage area.
Conduct in-home health evaluations to review medical history, perform physical assessments, and provide diagnostic services. Engage with patients to bridge gaps in care and facilitate connections to appropriate health resources.
Conduct comprehensive in-home health evaluations for patients, including medication reviews and physical assessments. Provide patient education and facilitate connections to appropriate care services to improve health outcomes.
The physician will conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They will also perform virtual visits and provide diagnostic services while maintaining detailed clinical documentation.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide connections to appropriate health services.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide health education and bridge gaps in care while maintaining accurate clinical documentation using an iPad.
The physician will conduct in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. They will also perform diagnostic and preventive services while maintaining clinical documentation via an iPad.
The Strategic Account Executive is responsible for managing the overall account strategy, renewal outcomes, and executive relationships for a portfolio of large, complex pharmacy benefit clients. This role involves leading financial negotiations, providing strategic recommendations, and coordinating across internal teams to ensure client retention and growth.
You will design, build, and operate large-scale observability services while leading the enterprise-wide adoption of OpenTelemetry standards. The role involves developing high-performance backend services and collaborating with cross-functional teams to ensure reliable, secure, and cost-efficient telemetry pipelines.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
You will architect and scale high-throughput telemetry pipelines while leading enterprise-wide adoption of OpenTelemetry. Additionally, you will design and operate core observability services and collaborate with SRE and platform teams to ensure system reliability.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Build trusted relationships with patients to bridge care gaps and provide personalized health education.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge care gaps and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews and physical assessments. Provide patient education and bridge gaps in care while traveling across a defined coverage area.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide necessary health education.
Conduct in-home health evaluations, including physical exams, medication reviews, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic screenings for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Provide one-on-one home infusion nursing care and patient education in accordance with the physician’s plan of treatment. Perform infusion therapies in patient homes and participate in telephonic on-call rotations.
Conduct in-home and virtual health evaluations, including medication reviews, physical assessments, and diagnostic screenings. Build trusted relationships with patients to bridge gaps in care and provide health education.
The Senior Cloud Data Security Engineer will design and implement enterprise-wide Data Loss Prevention (DLP) policies across cloud, endpoint, and AI/ML environments. This role involves monitoring data leakage incidents, automating response workflows, and collaborating with cross-functional teams to ensure robust data protection.
The Clinician Field Mentor performs in-home health evaluations for up to 80% of their time while providing mentorship and guidance to new and active clinicians. They also serve as an early adopter for new clinical workflows and diagnostic services to ensure high standards of care.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health insights.
Conduct comprehensive in-home health evaluations, including physical assessments and medication reviews, to bridge gaps in patient care. Provide patient education and facilitate connections to appropriate care services while maintaining accurate clinical documentation.
Conduct in-home health evaluations, including physical exams, medication reviews, and diagnostic tests to bridge gaps in patient care. Build trusted relationships with patients and provide comprehensive health assessments while maintaining accurate clinical documentation.
The Case Management Analyst coordinates care and facilitates access to healthcare services by assessing member needs and developing effective care plans. They also monitor progress, document activities, and ensure compliance with regulatory standards and quality management guidelines.
The Clinician Field Mentor conducts in-home health evaluations for members while providing mentorship and guidance to new and active clinicians. This role also serves as an early adopter for new clinical workflows and diagnostic services to ensure high-quality care standards.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide patient education and facilitate connections to appropriate care services based on individual health needs.
The Pharmacy Technician acts as a liaison between patients, providers, and pharmacists to manage medication refills and renewals. They are responsible for handling high volumes of inbound and outbound calls while documenting patient requests and coordinating with care teams.
Conduct in-home health evaluations including medication reviews, physical assessments, and diagnostic screenings for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic screenings. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
The representative will make over 300 outbound telemarketing calls daily to prospective patients to convert them into new patients. They are responsible for understanding patient needs, explaining the company's value proposition, and scheduling doctor's appointments while meeting performance quotas.
The Territory Sales Executive is responsible for selling specialty pharmacy services to physicians, hospitals, and medical clinics within the Central Michigan region. They will independently execute marketing plans and serve as the primary contact for providers to support patients with chronic illnesses.
The Sales Vice President is responsible for developing and executing sales strategies to drive membership growth and new logo wins within the National Accounts South region. This includes managing consultant relationships, leading finalist presentations, and collaborating with cross-functional teams to deliver competitive RFP submissions.
The Lead Director will shape the technology strategy, governance, and operational excellence for the Third-Party Administrator and Payer Solutions organization. They will serve as a trusted advisor to executive leadership, overseeing portfolio governance, financial management, and strategic execution to drive business growth.
The Care Manager facilitates the delivery of healthcare benefits and coordinates case management activities for chronically ill members across the continuum of care. They act as a liaison between members, providers, and insurance carriers to optimize wellness outcomes and ensure appropriate condition management.
Lead back-end engineering teams to create exceptional member experiences through digital services and cloud migration. Provide strategic guidance, coaching, and technical vision while integrating emerging AI technologies to enhance operational efficiency.
Conduct comprehensive in-home health evaluations, including physical exams and medical history reviews, to bridge gaps in care. Provide diagnostic and preventive services while building trusted relationships with patients in their homes.
The Medical Director oversees oncology-specific utilization reviews, quality assurance, and medical policy implementation. They serve as a clinical liaison to network providers and support the development of medical management programs.
Provide compassionate in-home health services to individuals and families within the Durango and La Plata County area. Collaborate with colleagues to simplify the healthcare experience and prioritize patient safety and quality.
Lead the end-to-end management of encounter and claims data submissions to state agencies, ensuring accuracy and regulatory compliance. Partner with technical teams and vendors to monitor 837 file transmissions and resolve data quality errors.
Conduct comprehensive in-home health evaluations, including physical exams and medical history reviews, to bridge gaps in care. Build trusted relationships with patients and provide connections to appropriate healthcare services based on unique needs.
Conduct comprehensive in-home health evaluations, including physical exams and medical history reviews, to bridge gaps in care. Provide diagnostic and preventive services while building trusted relationships with patients in their homes.
Conduct comprehensive in-home health evaluations, including physical exams and medical history reviews, to bridge gaps in care. Provide diagnostic and preventive services while building trusted relationships with patients in their homes.
The Case Management Coordinator evaluates members' needs and coordinates care plans to achieve optimal healthcare outcomes. They also consult with various stakeholders to overcome barriers and ensure quality of care.
The role involves providing in-home health evaluations and building trusted relationships with patients to improve their health outcomes. Clinicians will engage with patients, review their medical history, and conduct physical evaluations.
The physician will conduct in-home health evaluations, engaging with patients to answer health questions and review their medical history. They will build trusted relationships and help bridge gaps in care while providing personalized health evaluations.
The clinician will provide in-home health evaluations, engaging with patients to bridge gaps in care. They will conduct assessments, answer health questions, and build trusted relationships to improve health outcomes.
The role involves conducting in-home health evaluations, building trusted relationships with patients, and providing personalized health assessments. Clinicians will engage with patients to answer health questions and bridge gaps in care.
Conduct in-home health evaluations for patients, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge care gaps and provide personalized health insights.
Conduct in-home health evaluations, including physical assessments, medication reviews, and diagnostic tests for health plan members. Provide patient education and bridge gaps in care while maintaining accurate clinical documentation via an iPad.
Conduct comprehensive in-home health evaluations, including medication reviews, physical assessments, and diagnostic testing for health plan members. Provide patient education and bridge gaps in care to improve health outcomes while maintaining detailed clinical documentation.
Conduct in-home health evaluations for patients, including physical assessments, medication reviews, and diagnostic testing. Provide patient education and bridge gaps in care to improve overall health outcomes.
Conduct comprehensive in-home health evaluations for health plan members, including medication reviews and physical assessments. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct in-home health evaluations for health plan members, including medication reviews, physical assessments, and diagnostic testing. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Provide in-home health evaluations for health plan members, including medication reviews and physical assessments. Conduct virtual visits as needed and provide health education to improve patient outcomes.
Conduct in-home health evaluations, including medication reviews, physical assessments, and diagnostic tests for health plan members. Build trusted relationships with patients to bridge gaps in care and provide personalized health education.
Conduct comprehensive in-home health evaluations for health plan members, including physical assessments and medication reviews. Build trusted relationships with patients to bridge care gaps and provide necessary health education.
Conduct in-home health evaluations for patients, including medication reviews, medical history assessments, and physical examinations. Provide patient education and facilitate connections to appropriate care based on individual health needs.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments for health plan members. Provide patient education and facilitate connections to appropriate care services to improve health outcomes.
Conduct in-home health evaluations for patients, including physical assessments, medication reviews, and medical history documentation. Provide comprehensive health education and bridge care gaps while maintaining accurate clinical records using an iPad.
Conduct in-home health evaluations, including medication reviews, medical history assessments, and physical evaluations for health plan members. Provide patient education and facilitate connections to appropriate care to improve overall health outcomes.
Conduct comprehensive in-home health evaluations, including medication reviews and physical assessments, to bridge gaps in patient care. Provide health education and facilitate connections to appropriate care services based on individual patient needs.
Conduct in-home health evaluations for members, including medication reviews, medical history assessments, and physical evaluations. Provide diagnostic and preventive services while building trusted relationships to help bridge gaps in patient care.
This role involves providing in-home care as a Nurse Practitioner or Physician Assistant, contributing to building a connected, convenient, and compassionate health experience for individuals. The position is full-time, anticipating 40 weekly hours, and is part of a team dedicated to simplifying healthcare one person, one family, and one community at a time.
The clinician will conduct comprehensive in-home health evaluations lasting about 45 minutes, which includes reviewing medical history, performing a physical evaluation, and potentially administering diagnostic tests. This role involves engaging with patients locally and virtually to bridge gaps in care and build trusted relationships.
The physician will provide in-home health evaluations lasting about 45 minutes, which includes medication and medical history review, a physical evaluation, and potentially diagnostic tests. This role involves joining a national network of clinicians dedicated to improving health outcomes by visiting millions of people nationwide.
The clinician will conduct comprehensive in-home health evaluations lasting about 45 minutes, which includes reviewing medical history, medications, and performing physical evaluations. This role focuses on connecting with patients to bridge gaps in care and providing necessary diagnostic and preventive services as ordered.
The clinician will conduct in-home health evaluations lasting about 45 minutes, which includes reviewing medical history, performing physical evaluations, and potentially administering diagnostic tests. They will join a national network of clinicians dedicated to improving health outcomes by connecting people to the right care for their unique needs.
The physician will conduct in-home health evaluations, engaging with patients to answer health questions and review their medical history. They will also provide connections to appropriate care based on individual needs.
The clinician will provide in-home health evaluations, engaging with patients to bridge gaps in care. They will conduct assessments, answer health questions, and build trusted relationships to improve health outcomes.
The Physician will provide In-Home Health Evaluations, which include medication and medical history review, a physical evaluation, and potentially diagnostic tests, lasting about 45 minutes per visit. They will join a national network of clinicians dedicated to improving health outcomes by connecting millions of people nationwide to the right care for their unique needs.
The physician will conduct in-home health evaluations, engaging with patients to answer health questions and review their medical history. They will also help bridge gaps in care and connect patients to the right services.
The physician will conduct in-home health evaluations, engaging with patients to bridge gaps in care. This role involves building trusted relationships and providing personalized health evaluations.
The clinician will conduct in-home health evaluations, engaging with patients to assess their health needs and provide personalized care. This role requires extensive travel within a defined coverage area to meet patients in their homes.
The role involves conducting in-home health evaluations and engaging with patients to bridge gaps in care. Clinicians will connect with patients, review their medical history, and perform physical evaluations.
The physician will conduct in-home health evaluations, engaging with patients to review their medical history and perform physical evaluations. They will also help bridge gaps in care and connect patients to the appropriate health services.
The clinician will conduct in-home health evaluations, engaging with patients to answer health questions and review medical histories. They will also provide diagnostic and preventive services as needed.
The Care Management Associate manages enrollment for the Children’s Specialty program and supports comprehensive coordination of medical services. This includes developing wellness plans, engaging community resources, and ensuring effective utilization of healthcare services.
The Care Management Coordinator collaborates and informs the case management process to facilitate appropriate healthcare outcomes for members. This includes conducting comprehensive evaluations, coordinating care plans, and monitoring progress to ensure quality of care.
Responsible for all population health management components and oversee the strategic design, implementation, and evaluation of population health initiatives. Develop and implement operational plans that align with established population health goals and coordinate with various stakeholders on population health activities.
The Senior Manager of Clinical Innovation manages and drives use cases within the clinical innovation portfolio to solve key business problems. This role involves collaborating with cross-functional teams to develop, test, and implement innovative solutions.
As a Staff Software Development Engineer, you'll lead efforts to create end-to-end CI/CD pipelines and build applications and tools that enhance the deployment experience across CVS Enterprise. You'll focus on delivering scalable solutions that improve customer experience and align with enterprise initiatives.
The Medical Director (Spine) will expand Aetna's medical management programs to address member needs across the continuum of care and support the Medical Management staff. They will lead utilization review and quality assurance, providing clinical expertise and business direction in support of medical management programs.
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and pre-certification as well as concurrent review.
The Care Management Associate manages enrollment for the Children’s Specialty program and supports comprehensive coordination of medical services. This role involves developing wellness plans, engaging community resources, and ensuring effective utilization of healthcare services.
The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent review.
The Medical Director will oversee medical policy implementation and participate in the development and evaluation of clinical programs. They will focus on utilization review and quality assurance, ensuring effective execution of medical services programs.
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and concurrent review.
The UM Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent review.
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and pre-certification as well as concurrent review.
The Medical Director will direct daily work on Part C appeals and provide support to appeal nurses. They will also monitor IRE and collaborate with Medicare Quality and Compliance.
The Medical Director will ensure timely and consistent responses to members and providers related to precertification, concurrent review, and appeal requests. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well as concurrent review.
The Case Manager is responsible for assessing, planning, implementing, and coordinating case management activities to evaluate the medical needs of members. They develop proactive care plans and collaborate with various stakeholders to enhance member wellness and address health and social challenges.
Lead the design and development of solutions for complex technical projects while acting as a subject matter expert. Collaborate with various stakeholders to solve technical problems and ensure timely progress of system design and development tasks.
The Staff Software Development Engineer will design, build, and deploy infrastructure capabilities for database technologies in various cloud environments. They will collaborate with multiple teams to create automation and improve customer experiences.
The Manager will support key financial initiatives through financial modeling, capital planning, and business case development. This role involves collaboration across teams to drive data-informed decisions and operational efficiency.
The Case Manager RN is responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs. This role involves developing proactive strategies to enhance members' overall wellness and facilitate smooth transitions to Aetna programs and plans.
The Care Management Associate will interface with various groups providing care coordination services for eligible children and young adults receiving Medicaid services in Ohio. They will handle administrative tasks, including managing inbound care management inquiries and processing referrals.
The Care Management Associate manages enrollment for the Children’s Specialty program and supports comprehensive coordination of medical services. This includes developing wellness plans, engaging community resources, and ensuring effective utilization of healthcare services.
The Care Management Coordinator collaborates with various stakeholders to facilitate healthcare outcomes for members by providing care coordination, support, and education. They conduct comprehensive evaluations of members' needs and implement care plans while monitoring progress.
The Lead Director of UM Innovation Delivery manages and drives initiatives to solve key business problems and create new value for Utilization Management. This role involves leading strategic projects, collaborating with senior leadership, and overseeing the execution of complex initiatives aligned with corporate goals.
As a Medical Economics Analyst, you will provide consultative support and medical cost-based analysis of markets and network initiatives. You will analyze utilization and unit cost medical cost drivers and manage multiple projects to improve patient care.
As a Product Manager, you will provide technical, analytical, and business support for Medicare, Medicaid, and Commercial products. You will develop business requirements, analyze program reporting, and ensure compliance with client and regulatory requirements.
This role ensures clinical programs and workflows are delivered accurately and on time, focusing on evaluating population health programs within Value Based Contracting. The Clinical Consultant provides consultative solutions to improve quality, increase efficiency, and drive cost savings within client organizations.
