CVS Health

Analyst

• Leverage analytical skills to review claims data and identify patterns of suspected potential FWA.
• Assist in the triage, preliminary investigation of all internal and external FWA complaints
• Refer all cases of suspected FWA to regulatory agencies within required timeframes.
• Assist in the monitoring of the FWA hotline and FWA shared email box
• Participate in the prepayment review process including detailed review of medical records against claims data

Senior Analyst, Fraud, Waste and Abuse Investigation

Pharmacist

• Helping to manage and improve patient health through safe and appropriate dispensing
• Supporting the management, oversight, and operation of all aspects within your pharmacy
• Strengthening pharmacy performance measures through effective coaching
• Contributing to positive patient experiences by showing empathy and genuine care
• Proactively offering and delivering immunizations to keep patients healthy
• Supporting the effective management of pharmacy inventory

Staff Pharmacist, Part Time

Consultant

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
• Communicates with providers and other parties to facilitate care/treatment.
• Identifies members for referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Utilization Management Nurse Consultant

Product Designer

• Own design and delivery of core experiences
• Clearly communicate experience intent and guide conversation and decisions across product, design, and engineering partners
• Set clear direction and maintain a high bar for quality
• Champion user needs while balancing business goals and technical constraints
• Simplify complex problems and guide teams toward clear, actionable solutions
• Partner with product and engineering to define requirements and align on priorities
• Oversee the creation of key design artifacts (development-ready design, journey maps, service flows)
• Ensure delivery of intuitive end-to-end experiences across web and mobile platforms
• Guide the development of prototypes that reflect both user experience and underlying logic
• Promote accessible and inclusive design practices across all work

Senior Experience Designer

• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
• Communicates with providers and other parties to facilitate care/treatment
• Identifies members for referral opportunities to integrate with other products, services and/or programs
• Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Marketing

• Support the design, implementation, and maintenance of planning and resource management processes.
• Help establish and reinforce team-wide norms, workflows, and governance practices.
• Develop repeatable templates, frameworks, and schedules.
• Partner with portfolio and functional leaders to help sequence work, manage capacity, and surface risks.
• Serve as the primary owner and subject-matter expert for Asana within the organization.
• Translate planning processes into intuitive Asana workflows.
• Train, coach, and support teams to drive strong adoption of project management tools.
• Translate complex, cross-functional work into clear, concise leadership-ready materials.

Senior Manager, Strategic Marketing

Manager

• Dedicate 50-75% of the day to engaging with members and coordinating their care.
• Utilize all available resources to connect with and engage 'hard-to-reach' members.
• Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
• Maintain meticulous documentation of care management activities in the member’s electronic health record.
• Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
• Identify and connect members with health plan benefits and community resources.
• Meet regulatory requirements within specified timelines.

Care Manager – Specialist

General

• Documenting Patient Encounters ~ 80%
• Joining the provider in the exam room to observe patient visits
• Documenting patient encounters in a structured note, including the history of the present illness, assessment, plan, and physical exam
• Assigning appropriate CPT and ICD-10 codes
• Preparing After Visit Summaries
• Consulting with provider to ensure accurate and specific documentation
• Clinical Documentation Improvement ~ 10%
• Requesting and reviewing medical records
• Leveraging Oak Street's population health tools to support clinical documentation improvement
• Preparing for and supporting Daily Huddles and Clinical Documentation Reviews
• Consulting with provider on clinical documentation opportunities
• Administrative support for your provider and care team ~ 10%
• Placing orders orders and referrals
• Addressing tasks
• Supporting the care team with additional responsibilities related to clinical documentation
• Other duties as assigned

Medical Scribe

• Conduct the annual Health Risk Survey to support needs identification for the member’s Individual Plan of Care
• Inform the assigned care manager of newly identified health/safety risks or service needs
• Complete care coordination activities delegated by the care manager within an established timeframe
• Inform the assigned care manager and/or associate manager of any identified quality of care issues
• Passionately support the member’s care coordination needs and drive solutions to address those needs
• Use problem-solving skills to find alternative contact information for members who are unreachable by care management
• Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health
• Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies

Care Management Coordinator

• Engage with members and coordinate their care for 50-75% of the day
• Utilize resources to connect with 'hard-to-reach' members
• Develop individualized care plans with members
• Maintain meticulous documentation of care management activities
• Work with the Interdisciplinary Care Team to address barriers to care
• Identify and connect members with health plan benefits and community resources
• Meet regulatory requirements within specified timelines

Case Management Specialist

Data Analyst

• Generate insights, build machine learning, deep learning and statistical predictive models
• Deploy large scale machine learning and deep learning models in production environment
• Effectively collaborate cross functionally with Data Engineering, IT and other technical teams
• Perform data quality assessments, remediate or curate data as necessary, perform data modeling
• Write complex and efficient SQL code and leverage Exploratory Data Analysis techniques
• Communicate complex modeling outputs into clear business narratives
• Prepare communication material such as presentations and reports
• Mentor peers and lead intern projects

Senior Data Scientist – PBM Analytics

Account Manager

• Develop annual brand and media strategies aligned with advertiser goals and growth objectives.
• Create campaign strategies and audience targeting recommendations tailored to brand and product lines.
• Build strategic supplier growth proposals based on a deep understanding of supplier business goals and marketing objectives.
• Serve as the primary liaison for supplier communications, including feedback, approvals, and creative revisions.
• Maintain strong relationships with clients, managing day-to-day business and identifying opportunities to drive incremental revenue.
• Educate advertisers on performance metrics, insights, and optimization strategies to improve results.
• Lead campaign kick-offs, manage briefs, and confirm media planning details.
• Oversee campaign performance in collaboration with internal teams.
• Monitor campaign performance using KPIs and data-driven insights to optimize outcomes.
• Perform in-depth data analysis to deliver actionable insights and recommendations for short- and long-term media strategies.
• Collaborate with Insights and Strategy team to ensure reporting accuracy.
• Deliver campaign performance reports, conduct wrap-up calls, and finalize Campaign Performance Reviews (CPRs).
• Work closely with sales, merchandising, and internal teams to drive strong results and advertiser satisfaction.
• Partner with campaign management, I&S, and billing teams to ensure seamless execution and accurate delivery.
• Support monthly billing processes and maintain Salesforce updates for campaign tracking.

Strategic Account Manager – CVS Media Exchange

Claims Specialist

• Perform claims analysis related to disputes, legal matters, state complaints, provider inquiries, and internal team inquiries
• Determine whether any claim payment or denial issues are present
• Submit the necessary documents to specific areas to ensure all is updated and corrected
• Submit all projects and/or claims to be reprocessed
• Perform education for providers, both internal and external, when required
• Attend provider group meetings, as well as individual meetings, both internally and externally
• Submit projects within Microsoft Excel as assigned
• Perform other duties as needed

Senior Claim Data Specialist, Provider Claims

• Conduct online “Video Visits” with health plan members
• Provide 40 hours of availability weekly, consistently providing 320+ capacity units per month
• Execute a strong visit completion rate, consistently pacing 220+ completed visits per month
• Maintain training, affiliation, and compliance with Video Visit requirements (regular training required)

Virtual Clinician, Home Evaluations, Physician

• Partner with Aetna clients, internal business units, and external vendors to design and deliver wellness initiatives
• Lead planning and implementation of onsite biometric screenings
• Monitor participation and implement strategies to increase engagement
• Establish rapport with plan sponsors and engage leaders in data-driven decision-making
• Support development of wellbeing champion network
• Educate customers on available health resources
• Serve as subject matter expert on wellbeing initiatives
• Lead in-person or virtual presentations to promote health education and well-being initiatives
• Build trusting relationships and rapport with customers, internal partners, and external vendors

Senior Analyst, Fraud, Waste and Abuse Investigation

Staff Pharmacist, Part Time

Utilization Management Nurse Consultant

Senior Experience Designer

Utilization Management Nurse Consultant

Senior Manager, Strategic Marketing

Care Manager – Specialist

Medical Scribe

Care Management Coordinator

Case Management Specialist

Senior Data Scientist – PBM Analytics

Strategic Account Manager – CVS Media Exchange

Senior Claim Data Specialist, Provider Claims

Virtual Clinician, Home Evaluations, Physician

Wellness Manager