- CVS Health (Jefferson City, MO)
- …The **Utilization Management Clinical Nurse Consultant** utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit ... management program. **Job duties include (but are not limited to):** + Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. + Consults and… more
- CVS Health (Jefferson City, MO)
- …A Resolution Team Specialist advocates for the patient and portrays "Putting People First" by taking a hands-on approach to help people on their path to better ... health. In this role, a Resolution Team Specialist will provide a high level of customer service, resolve escalations, and report potential trends to Leadership for review. **Job Responsibilities:** + Develop a deep understanding of Coram processes and learn… more
- CVS Health (Jefferson City, MO)
- …The Compute Engineer is an integral part of our growing team. The right candidate will report to the Infrastructure Manager. **Core Responsibilities:** **Engineering ... and Provisioning** + Engineering of related solutions for various project and operational needs. + Install new / rebuild existing servers (on-prem and cloud) and configure hardware, peripherals, services, settings, directories, storage, etc. in accordance with… more
- CVS Health (Jefferson City, MO)
- …Oak Street Health is a rapidly growing company of community-based healthcare centers delivering a new model of care for adults on Medicare. By providing comprehensive ... and integrated care, we improve outcomes, manage costs, and offer an unmatched experience for our patients. As a Senior Product Manager, you will be a key leader in our organization, responsible for driving the strategy and execution for a core part of our… more
- CVS Health (Jefferson City, MO)
- …+ Bilingual Spanish speakers encouraged + Remote position + Hours: Monday - Friday (window will be within 8 AM - 8 PM CST) + *Pharm Tech License not required* ... Questionnaire - + List city/state at top of resume (Able to work from any US state) + Adequate home internet required. High Speed Internet preferred. Required minimum speeds of 50 mb/sec download and 5 mb/sec upload. INCLUDE SCREENSHOT AT TOP OF RESUME PLEASE.… more
- CVS Health (Jefferson City, MO)
- …Dynamic Senior Business Consultant with a strong background in product management, operational excellence, and vendor solution management. The ideal candidate will be ... passionate about driving product vision and strategy, optimizing operational processes, and building strong partnerships with external vendors to deliver innovative solutions that meet business and customer needs. **Required Qualifications** + 5+ years in a… more
- CVS Health (Jefferson City, MO)
- …and Ownership You will operate as a high-impact technical individual contributor, owning the delivery and operational excellence of critical platform components. Your ... At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans… more
- CVS Health (Jefferson City, MO)
- …+ This position is for an Inbound/Outbound Queue Associate with American Health Holdings Medical Management Customer Service Department. + The job is part of a ... fast-paced environment in which high level customer service is a must. + Promotes/ supports quality effectiveness of healthcare services. **Required Qualifications** + 1+ years of call center experience. + 1+ years of medical/ healthcare experience. + 1+ years… more
- CVS Health (Jefferson City, MO)
- …CVS Health has an exciting opportunity to join our Pharmacy Services Finance Enablement team as a Senior Analyst on our Policies, Procedures, and Controls Team. The ... candidate will be responsible for the governance of policies and procedures across the Pharmacy Services Finance department along with supporting SOX, SOC, and Audit testing through providing support/evidence to our internal and external audit teams. This… more
- CVS Health (Jefferson City, MO)
- …- Maintains the Provider Data (demographic and contractual) for all network and non-network providers. - Ensures all provider information is accurately recorded and ... maintained to provide for proper reimbursement and member access (ie, directory listings). - Develops and maintains standards for database integrity, corrective actions, database alignment, and manages communication processes with other departments regarding… more
- CVS Health (Jefferson City, MO)
- …As a Clinical Formulary Strategy Pharmacist, you will play a key role in the assessment and execution of formulary strategy for the Commercial line of business. What ... will you do: **Formulary Management & Oversight** + Formulary Oversight for all Fully Insured Business + Collaborate with Utilization Management to develop and implement Prior Authorization Criteria specific to Aetna. **Cost of Care Initiatives** + Cross… more
- CVS Health (Jefferson City, MO)
- …will include but are not limited to: *You will lead development estimation activities and present to senior leaders. *You will make certain appropriate and effective ... data integration across multiple applications *You will provide solutions and design complex functionality within the RxClaim application (adjudication area) *You will positively mentor and lead assigned team projects and mentor junior resources as needed *You… more
- CVS Health (Jefferson City, MO)
- …We are looking for a Senior Platform Engineer to be a core member of our team responsible for the health, stability, and growth of our Azure Databricks data ... engineering platform. We also have current data Platforms on-prem (MS SQL server) and Cloud (Palantir Foundry) that this role will support those platforms as well until we have migrated off those platforms and completely on Azure Databricks. In this role, you… more
- CVS Health (Jefferson City, MO)
- …We are seeking an experienced and strategic leader to oversee Change and Release Management for the Aetna Line of Business (LOB). This role is pivotal in ensuring the ... delivery of high-quality, reliable technology releases through close collaboration with Application Development, Infrastructure, Security, and other cross-functional teams. The ideal candidate will drive architectural alignment, risk mitigation, and process… more
- CVS Health (Jefferson City, MO)
- …CVS Aetna has an opportunity available for a full time Customer Service Representative in the Behavioral Health team. This role provides advocate care to assist the ... member with a clear path to care, claims understanding and resolution and educates the member with online resources. The Customer Service Representative guides the member through their members plan of benefits, Aetna policy and procedures as well as having… more
- CVS Health (Jefferson City, MO)
- …**At a Glance** Signify Health is transforming how care is delivered by bringing essential health services into the home. As we expand beyond our core in-home ... evaluation offering, we are launching new in-home and virtual services to improve access, close care gaps, and manage chronic conditions. We are looking for a highly motivated Senior Product Analyst to support our growing product team. This role will partner… more
- CVS Health (Jefferson City, MO)
- …At CVS, we are building a next-generation Infrastructure Platform that empowers engineering teams across CVS Digital to deploy code and operate applications at the ... scale of a Fortune 10 enterprise. This platform will serve hundreds of engineers across Retail, Pharmacy, Health Solutions, and Aetna-supporting applications used by millions of customers. As a Senior Software Development Engineer - IaaS, you will be a key… more
- CVS Health (Jefferson City, MO)
- …The **Project Specialist, Health Proposals** will be actively participating in RFP ( _Request for Proposal)_ strategy calls, contributing insights, and subsequently ... At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans… more
- CVS Health (Jefferson City, MO)
- …The Sr Analyst, Application Support maintains, integrates, and implements software applications within the organization. The Sr Analyst coordinates software ... application testing, quality assurance, configuration, installation and support to ensure smooth, stable and timely implementation of new software and updates to installed applications. This role also ensures proper controls are established and maintained over… more
- CVS Health (Jefferson City, MO)
- …As a Compliance Clinical Pharmacist, you will play a key role in the assessment and execution of compliance regulations. You will leverage your clinical and business ... expertise to ensure Aetna pharmacy is meeting compliance standards as it relates to Mental Health Parity and state regulations Working closely with cross-functional teams, you will help prioritize regulatory responses, assess NQTL reporting, and assist with… more
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