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

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• Hartford, CT

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

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• VA

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

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

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

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• FL

Provide clinical, coding, and reimbursem*nt expertise as well as directing case management when necessary. support the Medical Management staff ensuring timely and consistent responses to members and providers.

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• AZ, CA, FL, IL, KS, KY, LA, MD, MI, NJ, NY, OH, PA, TX, VA, WV, OK

Bring your heart. Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

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• Woonsocket, RI, or US National

Innovate and achieve growth targets by staying ahead of healthcare trends, creating business cases, managing external relationships, and executing new initiatives. Draw insights from data and build innovative business ideas.

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• MI

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Majority of time is spent on telephonic outreach and documentation in a clinical...

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• Phoenix, AZ, or US National

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

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• NY, NJ

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

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• KS

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

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• Hartford, CT

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

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• Harrisburg, PA

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

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• RI

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

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• Bloomington, MN, Downers Grove, IL

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

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• TX

Maintain high production and quality. Develop credentialing processes and workflows. Identify improvement opportunities and recommend solutions. Provide telephonic education on credentialing policies and procedures.

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• OH

Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. Insures all compliance requirements...

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• MN

Perform routine quality audits for network operations and claim testing for PPO Network creation. Analyze data, identify errors, and develop quality programs to continually deliver quality service to internal and external customers.

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• Hartford, CT

Perform complex analytics and reporting to identify and prioritize members for prospective and retrospective programs, optimize risk scores while maintaining compliance, build reports and dashboards to track risk adjustment programs, and collaborate ..

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• MD

Coordinate medical services, perform non-medical research, maintain documentation, and promote communication with stakeholders. Sedentary work with visual acuity required. 2+ years clinical experience and high school diploma/GED required.

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• Hartford, CT

Review and rework sensitive, complex medical and hospital claims. Adjudicate claims in accordance with processing guidelines. Provide root cause analysis and resolution of affected claims. Ensure accurate and timely handling of rework projects.

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• US National

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

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• Phoenix, AZ

Assist with gathering information, assessing and fulfilling callers needs, and providing education along the way. Contribute to the achievement of service level goals. Collaborate with internal and external business partners to provide solutions.

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• FL

Collaborate with stakeholders to prioritize and develop security features. Communicate security vision and provide subject matter expertise. Stay updated on new security technologies. Drive agile product development and deliver business case recommen..

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• CT

Develop and optimize BI solutions, automation, and data intake leveraging Microsoft O365 suite of products. Collaborate with business stakeholders to provide targeted solutions. Possess strong technical and interpersonal skills.

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• MN

Lead efforts to build and design a Web Platform used by millions of customers. Collaborate with engineers, product managers, designers, and leadership to drive amazing customer experiences. Stay updated on emerging technologies and improve software q..

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• Hartford, CT

Maturing quality engineering, partnering with 3rd party provider and development teams for automation coverage, defining system and application performance analysis, providing operational and engineering support for large-scale software applications.

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• US National

Bring your heart to . Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

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• TX, AR, ID, CO, IN, NE, IA, NV, WY, MI, LA, TN

Provide holistic, evidenced-based care, including assessment, diagnosis, treatment, and health counseling for patients. Serve as a clinical expert and resource for clinical quality initiatives. Develop programs and provide process improvement insight.

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• TX

Bring your heart. Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world...

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• TX

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies.

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• NC

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate infertility services/benefits for members.

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• TX

Assess, plan, coordinate, evaluate, and advocate for patients' comprehensive health needs. Utilize best-in-class clinical models to deliver compassionate care and address patients' social determinant needs. Unrestricted RN licensure and experience wi..

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• NY

Bring your heart. Every one of us at shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world.

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• MI

Assess, plan, implement, and coordinate case management activities for members to evaluate their medical needs and enhance overall wellness. Collaborate with key stakeholders and utilize clinical judgment to address complex health and social indicators.

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• LA

Assess, plan, implement, and coordinate case management activities with members to evaluate medical needs and enhance short and long-term outcomes. Use clinical tools and information to conduct evaluations and apply clinical judgment to reduce risk f..

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• TX

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies.

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• MI, IN, KY, TN, GA, FL, OH, NC, SC, WV, VA, PA, DC, CT, NJ, NY, RI, NH, ME, MD, DE, VT, MA

Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.

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• PA

Assess, plan, implement, and coordinate case management activities to enhance member wellness. Conduct evaluations, develop proactive care plans, and collaborate with stakeholders to address complex health and social indicators. Minimum 3-5+ years cl..

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• Raleigh, NC

Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Interprets and utilizes clinical guidelines/criteria to positively impact members health.

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• High Point, NC

Assess, plan, coordinate, and implement all case management activities with members to evaluate medical needs, develop proactive course of action, reduce risk factors, and address complex health and social indicators.

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• US National

Utilization Management Nurse Consultant responsible for coordinating and documenting utilization/benefit management program, ensuring appropriate care, communicating with providers, and promoting quality healthcare services.

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• Woonsocket, RI

Accountable to formulate / define system scope and objectives to meet project deliverables, ensuring that established timelines and cost estimates are maintained.

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• FL

Assist clinical teams in providing optimal care by locating services, facilitating follow-up calls, collecting member progress information, and providing information on mental health resources and policies.

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• PA

Assist clinical teams in providing optimal care by locating services, facilitating follow-up calls, collecting information on member progress, and providing information to members regarding mental health and substance abuse benefits.

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• Boston, MA

Creating and evolving tools and automation to deliver accessible web and native experiences. Partnering cross-functionally to improve design deliverables. Maturing design processes and providing domain expertise in accessibility.

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• US National

Build and test durable, accessible components. Create clear documentation for engineers. Collaborate with design, accessibility, and engineering teams. Advocate for best practices and drive technical direction for iOS component library.

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• US National

Lead technical direction, standards, guidelines, and methodology for specified technologies in the department. Develop and improve strategic technical direction for functional areas. Lead matrixed application technical leads in the development...

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• TX

Manage and support communication needs of an Employee Assistance Program. Develop promotional materials, collaborate with clients and teams, track requests, and ensure content is up-to-date. Bring creative ideas and meet deadlines.

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• Hartford, CT

Install, configure, maintain, and monitor IBM MQ and ACE environment. Ensure reliability, performance, and security of message queueing systems. Administer MQ Series and implement security protocols in IIB environments.

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• VA, MD, Washington, DC

Negotiate and execute contracts with complex hospital systems, physician groups, and ancillaries. Manage contract performance and support strategic, value-based relationships. Recruit providers to achieve network expansion and adequacy targets.