CVS Health

Technical Project Manager

• Drive strategy alignment, planning, and execution rhythm across teams.
• Monitor dependencies and cross-functional efforts to mitigate critical risks to drive successful execution.
• Align portfolio objectives with organizational goals, ensuring that all projects contribute to the overall strategy.
• Support critical projects and initiatives, ensuring alignment with strategic goals and timely execution.
• Track progress and report on key performance indicators.
• Managing and tracking utilization and forecasted investments against the annual plan, ensuring financial resources are allocated efficiently.
• Develop and disseminate clear and effective communication materials, including presentations, reports, and memos for both internal and external stakeholders.
• Build and maintain relationships with leaders, cross-functional teams, and other program managers to facilitate collaboration and knowledge sharing.
• Gather, analyze, and present data to support decision-making processes, identify trends, and drive continuous improvement efforts.
• Act as a key problem-solving resource helping to address complex issues and challenges within the organization.
• Establish scalable processes, systems, and workflows to improve operational efficiency within the organization.
• Organize and lead meetings, and set agendas ensuring that discussions are productive, action items documentation, and decisions are followed through.
• Flexibility to adjust strategies and priorities in response to changing market conditions and organizational needs.

Digital Product Manager / Project Manager

Compliance

• Serve as the designated Compliance Officer for Aetna’s IL Medicaid health plan
• Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities.
• Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners
• Lead and execute all elements of the Medicaid compliance program for Aetna’s IL Medicaid health plan.
• Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements.
• Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests.
• Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes.
• Ensure that current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes.
• Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance.
• Lead and direct oversight and monitoring activities to evaluate levels of compliance with new and existing Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels.
• Maintain positive, productive relationships with internal and external senior level constituents to effectively communicate and influence ethical and compliant outcomes.
• Oversee the submission of required regulatory reports (standard and ad hoc), including the completion of high level quality reviews prior to submission and the maintenance of tracking systems and tools to document ownership, reporting requirements, and monitor timely delivery and acceptance of reports.
• Provide training and guidance to less experienced team members to accomplish goals.
• Other duties as assigned.

Lead Director – Corporate Compliance

Data Scientist

• own multiple concurrent projects across model development, strategic analysis, and analytics product delivery — framing the business question, designing the approach, building the solution, and presenting findings to senior stakeholders (Lead Director, Executive Director, AVP)
• set technical direction for your workstream, mentor junior data scientists, and partner directly with business leaders across sales, underwriting, and finance to turn analysis into action

Senior Data Scientist

Platform Engineer

• Design, build, and maintain key components of our data platform automation for provisioning, backups, and user management
• Troubleshoot and resolve complex performance and reliability issues in our data systems
• Proactively identify opportunities to improve data streaming services, security, scalability, and automation
• Participate in an on-call rotation to support the team's critical services
• Mentor junior engineers on the team

Senior Platform Engineer, Data & Performance Enablement

Manager

• Visiting members in their homes to evaluate for appropriateness for waiver services, writing the waiver and submitting for approval.
• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Case Manager, Registered Nurse - Field MI

Clinical Operations

• Working on the development, creation, maintenance, and management of the client-specific clinical benefits, formularies, and utilization management edits.
• Supporting the clinical and benefit teams in all clinical benefit and formulary set-up/coding efforts required to meet client-specific needs and requirements.
• Performing tasks associated with clinical benefit and formulary documentation and reporting needs across all lines of business offered by the client.
• Ensuring all relevant activities are at highest level of clinical appropriateness, accuracy, clinical consistency, and in full compliance with client requirements and applicable rules and regulations.

Clinical Pharmacist, Clinical Account Operations

Patient Care Coordinator

• Serve as the first point of contact for patients, caregivers, and healthcare providers—answering questions, resolving concerns, and providing education.
• Guide new patients through the onboarding process with empathy, professionalism, and attention to detail.
• Handle a high volume of phone calls, using active listening and de-escalation skills for challenging situations.
• Multitask and prioritize effectively—navigating multiple computer screens and systems while capturing all necessary patient information.
• Work independently from home, reliably following shift, break, and lunch requirements.
• Collaborate with internal teams to support referrals and admissions.

Pharmacist

• Collaborates with the technicians and prior authorization team members to process referrals
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design
• Guarantee that decisions regarding cases are conveyed promptly and efficiently
• Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients
• Establishes and maintains communication among CVS Caremark, health plan, and employer group staff
• Maintains professional and technical knowledge of drug and disease states
• Performs other related projects and duties as assigned

Clinical Pharmacist – Prior Authorization

Data Analyst

• Design and maintain the OpEx semantic data layer in Snowflake
• Develop and deploy advanced analytical models and AI/ML applications
• Build and maintain automation flows that eliminate manual reporting
• Develop network-level PowerBI dashboards
• Own OpEx's platform requirements and represent them directly in platform design
• Drive the OpEx analytics and AI roadmap
• Use data, modeling, and AI to optimize WMS/LMS settings
• Lead cross-functional analysis with routing, transportation, and inventory teams
• Translate analytical findings into actionable recommendations
• Lead root cause analysis and corrective action efforts
• Train OpEx colleagues and site leadership on tools and methods
• Mentor OpEx colleagues on advanced analytical techniques
• Plan and execute multiple projects in parallel

Senior Manager, Operational Excellence Analytics

Investigator

• conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse
• Investigate matters of program integrity to prevent payment of aberrant claims submitted to the Medicaid lines of business for payment
• Conduct thorough research on subject(s) and related entities
• Initiate independently proactive data mining using SIU Tools to identify aberrant billing patterns and early scheme detection
• Conduct extensive analysis of claims data to determine aberrancy, pattern, or scheme
• Research and prepare cases for both clinical and legal review
• Collaborate with Medical Directors on clinical issues and medical record questions
• Accurately documents all case activity and communications in designated case tracking system
• Communicate clinical findings to provider
• Adherent to all regulatory requirements
• Facilitate case outcomes for the recovery of company and customer monies lost from aberrant billing
• Provide training and guidance to new and junior investigators
• Assist junior Investigators in identifying resources for cases; offer suggestions on investigative strategy
• Serve as back up to the Team Leader as necessary
• Collaborate with federal, state, and local law enforcement agencies for the investigation and prosecution of healthcare fraud issues
• Experience in witness testimony; Proficient in testifying for both civil and criminal proceedings
• Communicate clearly a high level of FWA knowledge and understanding during interactions with both internal and external stakeholders
• Communicate ideas on efficiency gains; provides input regarding controls for monitoring FWA among the business segments

Senior Investigator, Special Investigations Unit

• Drive end‑to‑end project management for high‑impact workforce optimization initiatives, operating effectively in grey areas where requirements, risks, and stakeholder inputs may be evolving.
• Partner closely with Government Affairs, Legal, Talent Acquisition, Communications, and HR to scope work, align resources, manage timelines, mitigate risk while managing the project plan.
• Serve as an enterprise‑wide strategic advisor to leaders at all levels, providing consultative guidance in complex, ambiguous, and high‑impact scenarios where solutions are not clearly defined and require strategic judgment, influence, and risk assessment to inform workforce strategy and future‑state design.
• Influence talent decisions by evaluating current capabilities against future organizational needs, identifying skill gaps, and recommending workforce solutions that enable long-term business success and adaptability.
• Leverage data to proactively identify workforce activities and emerging risks, delivering actionable insights and strategic recommendations that inform organizational design and talent decisions.
• Lead strategic process improvements and system enhancements for severance administration technology, translating complex and evolving business and legal needs into scalable system requirements.
• Own end‑to‑end solution integrity by defining requirements, designing and executing test scripts, and overseeing full regression testing to ensure compliant, reliable, and future‑ready outcomes.
• Ensure compliance with state/federal laws (WARN, OWBPA, EEO Title VII, ERISA, Section 409A of the Internal Revenue Code, etc.) and company policies.

Senior Manager, Workforce Optimization

• Responsible for driving growth in Specialty by building innovative products
• Develop robust product roadmap based on current and anticipated market trends
• Collaborate across the organization to deliver new solutions to market
• Build and execute product roadmap that solves payor, provider and patient needs
• Leverage pharmacist expertise to inform clinical strategy and performance
• Assist in the development of tools and processes to improve effectiveness
• Collaborate with external partners to develop strategies for managing high-cost medical drugs

Senior Manager – Oncology & Rare Disease Products

Consultant

• Develop and maintain relationships with key benefit administration, decision support, enrollment, technology and emerging AI-enabled solution providers.
• Conduct research, analysis, and business assessments to identify opportunities and support strategic decision-making.
• Develop business cases, recommendations, presentations, and implementation plans that advance organizational priorities.
• Support evaluation, selection, implementation, and ongoing management of strategic third-party relationships.
• Monitor partnership performance and recommend opportunities for improvement, expansion, and optimization.
• Influence stakeholders across multiple business areas to drive alignment and successful execution of strategic initiatives.
• Serve as a liaison between internal teams and external partners to ensure delivery of business objectives.
• Support business technology initiatives that improve operational effectiveness, enrollment outcomes, and customer experience.

Senior Manager, Strategic Business Consultant – Supplemental Health

Director

• Managing strategic relationships with designated consulting and brokerage partners
• Supporting membership growth and customer engagement objectives
• Leading complex cross-functional initiatives
• Developing and maintaining engagement plans with partners
• Supporting consulting and brokerage partners with resources and tools
• Leading initiatives to increase participation and membership growth
• Analyzing business challenges and developing recommendations
• Developing business cases and executive-level presentations
• Coordinating regular business reviews with partners
• Providing leadership and development for the Strategic Partnerships team

Lead Director, Strategic Business Consulting, Supplemental Health

Artificial Intelligence

• Contribute to the strategic oversight and optimization of competitive intelligence and AI-enabled research capabilities.
• Support the Enterprise Strategy team's research tool ecosystem by partnering with the Lead Director.
• Act as the SME and product owner of the team’s knowledge management system (Crayon).
• Organize requirements and work with vendors on new features, oversee utilization reporting, and identify ways to leverage platforms for research needs.
• Partner closely with Strategy leaders and external vendors to align tool capabilities with evolving business needs.