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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• Nashville, TN

Lead team-members through engineering of IAM solutions, coordinate IAM team's work and keep projects on schedule, manage implementations and releases via CI/CD strategies, influence and align key stakeholders.

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• FL

Implement custom specialty networks, track and record network performance, respond to inquiries, assist with client network filing requests, generate reporting, analyze data, and perform other assigned tasks.

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• NY

Automate IT processes and develop solutions to enhance system monitoring, alerting, and reporting capabilities. Manage source code and version control using GitHub. Collaborate with cross-functional teams to streamline processes and troubleshoot issues.

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• KS

Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the mem...

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• Chicago, IL

Maintain operational excellence through matrixed leadership and oversight of our centralized medical management functions, as well as be the health plan's subject matter expert in medical management operations, including Utilization Management...

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• AZ

Develop architecture strategies, design execution, collaborate with stakeholders, lead teams, remove barriers, support diversity and inclusion, deliver executive presentations, and execute business plans.

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• TX

Lead process optimization, analysis, and improvement initiatives, utilizing Six Sigma, Agile, and Lean methodologies. Collaborate with cross-functional teams to streamline workflows, implement digital tools, and ensure compliance with organizational ..

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• OH, MS, TX, GA, NY, VA, IL, MA, NC, SC, CT, RI, TN, KY

Manage architectural design development and implementation of drawings for facilities, oversee project management of A&E firms and consultants, ensure conformance with standards and requirements, and manage multiple complex projects simultaneously.

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• Downers Grove, IL

Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Analyze all utilization, self report and clinical data available to consolidate information and begin to...

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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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• TX

Lead mental health and substance use disorder utilization and case management programs. Collaborate with state agencies, providers, and community partners to ensure program quality and integration. Provide strategic oversight for all behavioral healt..

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• KS

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

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• Columbus, OH

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

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• AZ

Assess, plan, implement and evaluate members' nutritional status. Utilize clinical tools and data to establish member's plan of care. Provide nutritional coaching and support to empower members to make healthy lifestyle choices.

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• OH

Leads and implements clinical and non-clinical activities to improve healthcare quality and outcomes. Develops and interprets medical policies and procedures. Provides clinical expertise and support for medical management programs.

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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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• Sacramento, CA, or US National

Lead medical management programs, provide clinical expertise, and act as liaison to network providers. Ensure timely and consistent responses to members and providers. Requires active medical license and board certification in Cardiology.

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• US National

Maintain accurate inventory of software assets and license compliance. Lead complex audits and manage key relationships with stakeholders. Streamline and automate software request process and identify cost-saving opportunities.

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• TX

Provide oversight for medical policy implementation, participate in program development and evaluation, and support medical management staff. Focus on utilization review/quality assurance and provide clinical expertise to support medical management p..

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• OH

Clinical Pharmacist providing comprehensive medication reviews, drug information, and medication education. Collaborates with interdisciplinary care management team to support members on their path to better health and reduce medical costs.

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• IL, WI, OH, MN, IN, MI

Provide oversight for medical policy implementation, develop and evaluate clinical/medical programs, support medical management staff, offer clinical expertise and business direction for medical management programs, and act as a liaison to network pr..

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• LA, AR

Manage relationships with assigned providers, optimize interactions, monitor service capabilities, educate providers, and conduct provider recruitment and contracting activities. Bachelor's degree preferred with 3 years of experience in business segm..

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• US National

Partner with Advocate team to assess member's needs, collaborate with providers, lead clinical staff, conduct rounds, provide clinical guidance, engage providers, identify quality improvement opportunities, collaborate with other functional areas.

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• VA

Lead clinical team to support health risk screenings, assessments, care plan development, and interventions. Develop and manage clinical operations to improve outcomes, member engagement, and satisfaction. Serve as liaison with regulatory agencies an..

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• Flower Mound, TX

As a Pharmacist for our Specialty Mail Service Pharmacy, you will provide exceptional customer service to patients and healthcare professionals, deliver pharmaceutical care services, and provide leadership and guidance to supporting staff.

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• TX

Perform intake of calls from members or providers regarding services via telephone, fax, EDI. Utilize system to build, research and enter member information. Screen requests for appropriate referral to medical services staff. Approve services that do..

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• NY

Develop and maintain relationships with key decision makers. Provide leadership to a cross-functional team. Act as a liaison between the client and the company. Offer cost-saving solutions and execute client renewals.

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• CA

Negotiate and execute contracts with Behavioral Health providers, manage contract performance, recruit providers, collaborate cross-functionally to manage costs, and support cost saving initiatives. Strong communication, critical thinking, and teamwo..

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• Austin, TX

Develop and advance business strategies, identify new partnerships and ventures, analyze market dynamics, communicate with senior leadership, and create strategic ideas. Bachelor's degree and experience in pharmaceutical industry required.

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• Cumberland, RI

Design, develop, and maintain automated solutions for Open Source and Oracle databases. Collaborate with software development teams to integrate database automation. Propose innovative solutions for process improvement and automation in the database ..

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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

Assess, plan, implement, and coordinate case management activities for members. Develop proactive care plans, conduct assessments, collaborate with stakeholders, and comply with policies and procedures. Minimum clinical experience required.

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• FL

Responsible for coordinating care for members experiencing a change in health status. Completes post-discharge questionnaires, provides discharge planning, ensures medication adherence, facilitates care coordination, and conducts interdisciplinary ca..

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• FL

Responsible for coordinating care for members experiencing a change in health status. Complete questionnaires, provide discharge planning, ensure medication understanding, educate on benefits, evaluate health indicators, and coordinate care with the team.

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• US National

Assess, plan, implement, and coordinate case management activities with members to evaluate medical needs and facilitate overall wellness. Develop proactive action plans, apply clinical judgement, and utilize case management processes to address heal..

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• MI

Assess, plan, implement, and coordinate case management activities. Develop proactive care plans, evaluate member needs, and collaborate with healthcare stakeholders. Utilize clinical tools and strategies to enhance member wellness.

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• OH

Assess, plan, implement, and coordinate case management activities with members to evaluate their medical needs. Develop proactive action plans, apply clinical judgment, and utilize case management processes to enhance member wellness.

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• CT

Drive provider satisfaction, cost targets, network growth and efficiency targets. Manage data quality during network development lifecycle and perform complex analysis on large data sets. Limited contract negotiation responsibilities for assigned pro..

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• US National

Lead a cross-functional engineering team, design new capabilities and integration patterns, drive solutions from idea to implementation, maintain architectural standards and patterns, and advance the modernization journey for Retail Technology team.

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• MI

Negotiate, execute, and analyze contracts with large hospital systems and physician groups. Manage contract performance and develop strategic relationships to expand provider networks. Identify cost-saving initiatives and ensure provider needs are met.

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• MI

Constructs negotiation, execution, review, and analysis of contracts. Delivers dispute resolution and settlement negotiations with providers. Ensures contract performance aligns with accessibility, compliance, quality, financial, and cost goals.

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• Scottsdale, AZ

Lead large, cross-organizational programs and projects with high visibility and critical timelines. Ensure successful delivery within scope, budget, and compliance. Resolve complex business issues and escalate when necessary.

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• GA

Assess and coordinate care for members with chronic illnesses, communicate with stakeholders, and document case work activities. Requires RN licensure, Mandarin fluency, and experience with Medicare members.

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• NJ, TX, NC, FL

Support comprehensive coordination of medical services including member outreaches, service authorizations, and member mailings. Utilize systems to enter member information, support care plan development, and arrange for health care service delivery.

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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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• 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..