-Managed Care experience.\u003C/span>\u003C/p>\u003Cp>\u003Cspan>-Medicaid experience.\u003C/span>\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">\u003Cb>Pay Range\u003C/b>\u003C/p>\u003Cp style=\"text-align:left\">The typical pay range for this role is:\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>$174,070.00 - $374,920.00\u003Cp style=\"text-align:left\">\u003Cbr />This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. \u003Cbr /> \u003C/p>\u003Cp style=\"text-align:left\">Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">\u003Cb>Great benefits for great people\u003C/b>\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:\u003C/p>\u003Cul>\u003Cli>\u003Cp style=\"text-align:left\">\u003Cb>Affordable medical plan options,\u003C/b> a \u003Cb>401(k) plan \u003C/b>(including matching company contributions), and an \u003Cb>employee stock purchase plan\u003C/b>.\u003C/p>\u003C/li>\u003Cli>\u003Cp style=\"text-align:left\">\u003Cb>No-cost programs for all colleagues \u003C/b>including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.\u003C/p>\u003C/li>\u003Cli>\u003Cp style=\"text-align:left\">\u003Cb>Benefit solutions that address the different needs and preferences of our colleagues\u003C/b> including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.\u003C/p>\u003C/li>\u003C/ul>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">For more information, visit \u003Ca target=\"_blank\" href=\"https://jobs.cvshealth.com/us/en/benefits\">\u003Cspan class=\"WJQ0\">https://jobs.cvshealth.com/us/en/benefits\u003C/span>\u003C/a>\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>We anticipate the application window for this opening will close on: 08/15/2025\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.\u003C/p>","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/KY---Work-from-home/Medical-Director---Kentucky-Medicaid_R0489083",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[516],{"city":8,"region":517,"country":33},"Kentucky","2025-07-16T00:00:00Z","Candidates must possess an active and current Kentucky state medical license without encumbrances and be able to obtain licenses for Florida, Louisiana, and West Virginia. An M.D. or D.O. with current and active board certification in an ABMS or AOA recognized specialty is required, along with post-graduate direct patient care experience. Preferred specialties include Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics. A minimum of five years of experience in a Health Care Delivery System, such as clinical practice or the health care industry, is necessary. Prior Utilization Management (UM) experience within a health plan/insurer, or experience as a Physician Advisor or with an Independent Review Organization is a plus. Preferred qualifications include health plan/payor UM/Review experience, electronic medical systems/record experience, managed care experience, and Medicaid experience.","The Medical Director will ensure timely and consistent responses to members and providers regarding precertification, concurrent review, and appeal requests. This role is primarily responsible for Utilization Management, encompassing prior authorization, pre-certification, and concurrent review for inpatient and outpatient cases. Responsibilities also include conducting peer-to-peer calls and handling first-level appeals.",{"employment":522,"compensation":525,"experience":526,"visaSponsorship":530,"location":531,"skills":532,"industries":538},{"type":523},{"id":114,"name":115,"description":524},"Commit to a standard 40-hour workweek, usually with full benefits.",{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":8},{"experienceLevels":527},[528],{"id":481,"name":482,"description":529},"Bring extensive experience to lead projects and mentor others.",{"type":49},{"type":49},[488,486,487,533,534,535,249,536,537],"Pre-certification","Concurrent Review","Appeals","Health Care Industry","Medical License",[539,540,542],{"id":61,"name":60},{"id":203,"name":541},"Managed Care",{"id":203,"name":543},"Medicaid",{"id":545,"title":546,"alternativeTitles":547,"slug":563,"jobPostId":545,"description":564,"applyUrl":565,"company":66,"companyOption":566,"locations":567,"listingDate":571,"listingSite":107,"isRemote":25,"requirements":572,"responsibilities":573,"status":110,"expiryDate":8,"summary":574},"89f1bd49-b93f-4c7c-b0d6-ccb41430f3b5","Social Worker - Field - Carroll County, GA",[548,549,550,551,552,553,554,555,556,557,558,559,560,561,562],"Field Social Worker Carroll County GA","Medical Social Worker Carroll County","Case Management Social Worker Georgia","Community Social Worker Carroll County","Home Visit Social Worker GA","Geriatric Social Worker Carroll County","Long-Term Care Social Worker Georgia","Field Case Manager Carroll County","Medical Case Manager Georgia","Social Worker Home Visits GA","Behavioral Health Social Worker Carroll County","Family Services Social Worker Georgia","Child Welfare Social Worker Carroll County","Outreach Social Worker Georgia","Healthcare Social Worker Carroll County","social-worker-field-carroll-county-ga-89f1bd49-b93f-4c7c-b0d6-ccb41430f3b5","# Job Description\n\n**Employment Type:** Full-time\n\n## Position Overview\n\nAt 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 through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.\n\n**Program Overview:**\nJoin our Aetna team as we lead the way in providing exceptional care to dual eligible populations! This role involves 50-75% travel. You will have a life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid and face a variety of complex health and social challenges. Through compassionate engagement and effective communication, we work collaboratively with members, healthcare providers, and community organizations to address the comprehensive healthcare and social needs of our members. Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country.\n\n**Position Summary:**\nAs a field Social Worker, you will play a vital role in the member-centered care planning process alongside the other core care team members. Your responsibilities will include:\n\n* Conducting field visits to the member’s home, community locations, medical facilities, and other locations.\n* Completing care management focused assessments.\n* Setting member-centered goals.\n* Identifying barriers and strategies to address them.\n* Establishing, monitoring, and adapting interventions to achieve member goals.\n\n## Fundamental Components\n\n* Focus on enhancing quality of care, ensuring compliance, improving outcomes, and reducing costs.\n* Develop and implement strategies to coordinate and integrate post-acute and long-term care services, preventing exacerbations and unnecessary custodial placements.\n* Perform initial and ongoing assessments for members enrolled in the Long-Term Care Program and other care initiatives.\n* Utilize social work principles and strategies to address the social determinants of health within each member’s individualized care plan.\n* Collaborate and facilitate ongoing communication with providers, primary care physicians, Medical Directors, pharmacists, and care management staff to discuss member status and progress toward goals.\n* Advocate for members to ensure they receive all necessary care covered by their benefit plans and available through Medicaid and community resources.\n* Build relationships with hospital social workers and community resources, leveraging data to ensure effective management of catastrophic, acute, and chronically ill members, aiming for appropriate utilization and reduced lengths of stay.\n* Assist in identifying and reporting potential quality improvement opportunities.\n* Direct social work interventions, including psychosocial assessments, follow-ups, in-home or facility assessments, documentation of issues and interventions, and facilitating access to a continuum of care through appropriate referrals.\n\n## Required Qualifications\n\n* **Residency:** Candidate must reside in Carroll County, Georgia (GA).\n* **Experience:** 2+ years of experience in medical social work or case management.\n* **Licensure:** Candidate licensure must comply with requirements in the state where job duties are performed.\n* **Travel:** Ability to travel within a designated geographic area for in-person case management activities (Travel expenses are reimbursed in accordance with the company travel reimbursement policy).\n* **Technical Skills:** Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Social Worker role.\n* **Work Environment:** Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually. Access to a private, dedicated space to conduct work effectively to meet the requirements.","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/GA---Work-from-home/Social-Worker---Field---Carroll-County--GA_R0659710",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[568],{"city":569,"region":570,"country":33},"Atlanta","Georgia","2025-07-21T00:00:00Z","Candidates must reside in Carroll County, Georgia, and possess at least 2 years of experience in medical social work or case management. Licensure must comply with state requirements, and proficiency in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) is necessary. The role requires the ability to travel within a designated geographic area and work independently from a private space.","The Social Worker will conduct field visits to members' homes, community locations, and medical facilities to complete care management assessments, set member-centered goals, and identify barriers to care. They will establish, monitor, and adapt interventions to achieve member goals, coordinate and integrate post-acute and long-term care services, and perform initial and ongoing assessments for members in the Long-Term Care Program. Responsibilities also include collaborating with providers and care management staff, advocating for members to ensure access to necessary care and resources, building relationships with community resources, identifying quality improvement opportunities, and performing direct social work interventions such as psychosocial assessments and referrals.",{"employment":575,"compensation":577,"experience":578,"visaSponsorship":584,"location":585,"skills":586,"industries":597},{"type":576},{"id":114,"name":115,"description":8},{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":8},{"experienceLevels":579},[580,583],{"id":581,"name":582,"description":8},"d9dd41a2-3551-412f-981e-de2bc1e7bb34","Mid-level (3 to 4 years)",{"id":481,"name":482,"description":8},{"type":49},{"type":49},[587,588,589,590,591,592,407,593,594,543,595,596],"Social Work","Care Planning","Field Visits","Assessment","Goal Setting","Intervention Strategies","Community Resources","Medicare","Communication","Compassionate Engagement",[598,599],{"id":61,"name":60},{"id":203,"name":496},{"id":601,"title":602,"alternativeTitles":603,"slug":614,"jobPostId":601,"description":615,"applyUrl":616,"company":66,"companyOption":617,"locations":618,"listingDate":622,"listingSite":107,"isRemote":56,"requirements":623,"responsibilities":624,"status":110,"expiryDate":8,"summary":625},"57329b63-6f86-485a-a617-b36dbdc78211","Senior COBRA Consultant",[604,605,606,607,608,609,610,611,612,613],"Senior COBRA Administrator","Lead COBRA Specialist","COBRA Compliance Manager","Benefits Administrator (COBRA Focus)","Senior Health Benefits Consultant","COBRA Operations Lead","Employee Benefits Specialist (COBRA)","Senior Benefits Enrollment Specialist","COBRA and HIPAA Compliance Specialist","Senior Benefits Consultant (COBRA)","senior-cobra-consultant-57329b63-6f86-485a-a617-b36dbdc78211","## Position Summary\nAt 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 through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.\n\nIn this role, you will:\n- Perform COBRA (Consolidated Omnibus Budget Reconciliation Act) administration requirements as your primary responsibilities.\n- Verify COBRA and retiree enrollment status, manage complex elections, terminations, reinstatements, terminations, and rate changes using proprietary systems, and addressing related eligibility questions or concerns.\n- Partner directly with clients, vendors, internal teams, and technical resources on COBRA eligibility-related issues and achieve positive service outcomes.\n- Collaborate with business partners to understand enterprise goals and contribute to solutions that support operational and compliance needs.\n- Deliver consulting services and support COBRA eligibility discrepancy resolution, data accuracy, and reporting alternatives.\n- Solve complex problems and take a new perspective on existing processes to drive improvements.\n- Design, develop, and deliver transitional training processes to support the onboarding of new employees and development of junior team members.\n- Ensure all communications involving sensitive member data adhere to HIPAA (Health Insurance Portability and Accountability Act) compliance requirements.\n\n## Required Qualifications\n- **1+ year** of experience working with COBRA, including knowledge of all relevant regulations.\n- **Highly proficient** in Microsoft Office products (Word, Excel, PowerPoint, Outlook).\n- **Must reside in East Lansing, MI.**\n- Ability to work a **hybrid schedule**, working 3 days per week in the East Lansing, MI office.\n\n## Preferred Qualifications\n- **5+ years** of experience working with COBRA.\n- **Strong written and verbal communication skills**, including active listening, professional phone etiquette, and attention to spelling, grammar, and proof reading.\n- Ability to **manage multiple tasks and shifting priorities** while maintaining accuracy and meeting deadlines.\n- **Self-motivated** and capable of working independently, with an understanding of intent and expectations.\n- **Detail-oriented** with a focus on producing accurate, timely results.\n- **Effective follow-up skills** to ensure resolution of open issues.\n- **Collaborative team player** who can operate independently when needed.\n- Ability to **coach and mentor others** as experience grows.\n\n## Education\n- High school diploma or GED.\n\n## Employment Type\n- Full time\n\n## Time Type\n- Full time\n\n## Anticipated Weekly Hours\n- 40\n\n## Pay Range\nThe typical pay range for this role is:\n- **$18.50 - $38.82**\nThis pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.\n\n## Benefits\nOur people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\n\n**Great benefits for great people**\nWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:\n- Affordable medical plan options\n- A 401(k) plan (including matching company contributions)\n- An employee stock purchase plan.\n- No-cost programs for all co","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/East-Lansing-3100-West-Road/Senior-COBRA-Consultant_R0641387",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[619],{"city":620,"region":621,"country":33},"East Lansing","Michigan","2025-07-23T00:00:00Z","Candidates must have at least 1 year of experience with COBRA administration and knowledge of relevant regulations. Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) is required. Candidates must reside in East Lansing, MI, and be able to work a hybrid schedule, with 3 days per week in the East Lansing office. A high school diploma or GED is required. Preferred qualifications include 5+ years of COBRA experience, strong written and verbal communication skills, the ability to manage multiple tasks and shifting priorities, self-motivation, detail-orientation, effective follow-up skills, and the ability to coach and mentor others.","The Senior COBRA Consultant will perform COBRA and retiree enrollment administration, including managing complex elections, terminations, reinstatements, and rate changes using proprietary systems. They will address related eligibility questions and concerns, partnering with clients, vendors, internal teams, and technical resources to resolve COBRA eligibility-related issues and achieve positive service outcomes. Responsibilities include collaborating with business partners to support operational and compliance needs, delivering consulting services, resolving COBRA eligibility discrepancies, ensuring data accuracy, and exploring reporting alternatives. The role involves solving complex problems, driving process improvements, designing and delivering transitional training, and ensuring all communications involving sensitive member data adhere to HIPAA compliance requirements.",{"employment":626,"compensation":628,"experience":629,"visaSponsorship":632,"location":633,"skills":635,"industries":645},{"type":627},{"id":114,"name":115,"description":8},{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":8},{"experienceLevels":630},[631],{"id":481,"name":482,"description":8},{"type":49},{"type":634},2,[636,637,638,639,640,641,642,643,644],"COBRA administration","HIPAA compliance","Microsoft Office Suite","Client relationship management","Data accuracy","Reporting","Problem-solving","Training development","Onboarding",[646,648],{"id":203,"name":647},"Health Services",{"id":203,"name":496},{"id":650,"title":651,"alternativeTitles":652,"slug":668,"jobPostId":650,"description":669,"applyUrl":670,"company":66,"companyOption":671,"locations":672,"listingDate":674,"listingSite":107,"isRemote":25,"requirements":675,"responsibilities":676,"status":110,"expiryDate":8,"summary":677},"7cdd0683-5bac-4569-8e83-6f83a461ad2c","Senior Data Scientist - Search and Personalization",[653,654,655,656,657,658,659,660,661,662,663,664,665,666,667],"Senior Search Scientist","Senior Personalization Data Scientist","Lead Data Scientist - Search Relevance","Machine Learning Scientist - E-commerce Search","Senior NLP Engineer - Search Personalization","Senior AI Scientist - Recommendation Systems","Data Science Lead - Search Algorithms","Senior Applied Scientist - Search & Ranking","Senior Machine Learning Engineer - Personalization","Senior Data Scientist - Ranking Systems","Senior NLP Data Scientist","Senior Search Relevance Engineer","Senior Data Scientist - Recommendation Engines","Senior Machine Learning Scientist - Search Personalization","Senior Data Scientist - E-commerce Personalization","senior-data-scientist-search-and-personalization-7cdd0683-5bac-4569-8e83-6f83a461ad2c","## About the Role\n**Employment Type:** Full time\n\nAt 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 through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.\n\n## Position Summary\nCVS is seeking a highly skilled and experienced **Senior Data Scientist** to join our growing team and revolutionize our e-commerce search experience. You will be responsible for developing and implementing innovative Neural Networks, kNN, natural language processing (NLP), learn-to-rank (LTR) solutions to power our search engine, ensuring our customers find the products they need quickly and efficiently.\n\n## What You Will Do\n- Designs and defines the technical architecture and infrastructure required for digital solutions\n- Writes code, develops software components, and implements complex functionalities according to project requirements\n- Collaborates with other members of the development team and stakeholders to make high-level architectural decisions, proposes design patterns, and ensures scalability, performance, and maintainability of digital solutions\n- Leverages advanced programming skills to design and implement complex features, optimize performance, and ensure code efficiency\n- Integrates various software components or systems, ensuring seamless communication and interoperability between different parts of the digital solution\n- Writes and executes comprehensive test cases, conducts code reviews, performs debugging, and troubleshoots issues to ensure the reliability, stability, and high quality of digital solutions\n- Participates in agile or other development methodologies, attends meetings, contributes to project planning, and helps drive the progress and success of digital projects\n- Explores new tools, frameworks, and techniques to improve digital solutions and drive innovation within the development team\n- Creates and maintains technical documentation, including system designs, architecture diagrams, code documentation, and other relevant documentation while sharing their knowledge and expertise with team members, ensuring effective knowledge transfer and collaboration\n\n## Required Qualifications\n- 5+ years of Data Science experience\n- 3+ years developing and implementing Neural Networks, kNN, natural language processing (NLP), learn-to-rank (LTR) solutions in a production environment\n- Deep understanding of various LTR algorithms, including LambdaMART, RankNet, and LightGBM\n- Strong programming skills in **Python** and experience with machine learning libraries such as scikit-learn, TensorFlow, and PyTorch\n- Experience working with large datasets and developing scalable data pipelines\n- Experience with A/B testing and data analysis for measuring model performance\n\n## Preferred Qualifications\n- Experience with eCommerce platforms and user behavior modeling\n- Familiarity with LLMs and generative AI applications in search\n- Knowledge of MLOps practices and model deployment pipelines\n- Passion for e-commerce and a deep understanding of user behavior\n- Contributions to open-source search or ML projects\n\n## Education\n- Bachelor’s degree or equivalent experience (HS diploma + 4 years relevant experience)\n\n## Business Overview\nBring your heart to CVS Health. Every one of us at CVS Health 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. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered.","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/GA---Work-from-home/Senior-Data-Scientist---Search-and-Personalization_R0658836",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[673],{"city":569,"region":570,"country":33},"2025-07-28T00:00:00Z","Candidates must have 5+ years of Data Science experience, with at least 3 years focused on developing and implementing Neural Networks, kNN, natural language processing (NLP), and learn-to-rank (LTR) solutions in a production environment. A deep understanding of LTR algorithms like LambdaMART, RankNet, and LightGBM is required, along with strong Python programming skills and experience with machine learning libraries such as scikit-learn, TensorFlow, and PyTorch. Experience working with large datasets, developing scalable data pipelines, and conducting A/B testing for model performance measurement is also necessary. A Bachelor's degree or equivalent experience is required.","The Senior Data Scientist will design and implement innovative Neural Networks, kNN, NLP, and LTR solutions to enhance the e-commerce search experience. Responsibilities include defining technical architecture, writing code, developing software components, and implementing complex functionalities. They will collaborate with the development team on high-level architectural decisions, propose design patterns, and ensure scalability and performance. The role involves integrating software components, writing and executing test cases, debugging, troubleshooting, and participating in agile development methodologies. Additionally, the Senior Data Scientist will explore new tools and techniques, create technical documentation, and share knowledge with team members.",{"employment":678,"compensation":680,"experience":681,"visaSponsorship":684,"location":685,"skills":686,"industries":699},{"type":679},{"id":114,"name":115,"description":524},{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":8},{"experienceLevels":682},[683],{"id":481,"name":482,"description":529},{"type":49},{"type":49},[687,688,689,690,691,125,692,693,694,695,696,697,698],"Neural Networks","kNN","Natural Language Processing (NLP)","Learn-to-Rank (LTR)","Search Engine Optimization","Scalability","Performance Optimization","Code Efficiency","System Integration","Testing","Debugging","Agile Methodologies",[700,701],{"id":61,"name":60},{"id":203,"name":204},{"id":703,"title":704,"alternativeTitles":705,"slug":716,"jobPostId":703,"description":717,"applyUrl":718,"company":66,"companyOption":719,"locations":720,"listingDate":722,"listingSite":107,"isRemote":25,"requirements":723,"responsibilities":724,"status":110,"expiryDate":8,"summary":725},"80af3933-54ce-417b-9e0f-0abe06b814e9","Medical Director - Medicare Appeals",[706,707,708,709,710,711,712,713,714,715],"Medicare Appeals Medical Director","Medical Director, Medicare Part C Appeals","Appeals Medical Director - Medicare","Medical Director, Health Plan Appeals","Senior Medical Director - Medicare Appeals","Medical Director, Utilization Management Appeals","Medical Director, Healthcare Appeals","Medical Director, Medicare Grievances and Appeals","Clinical Medical Director - Medicare Appeals","Medical Director, Health Services Appeals","medical-director-medicare-appeals-80af3933-54ce-417b-9e0f-0abe06b814e9","Employment Type: Full time\n\n\u003Cp style=\"text-align:left\">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.\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp>\u003Cb>Position Summary\u003C/b>\u003C/p>\u003Cp>\u003Cspan>Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.\u003Cbr />\u003Cbr />*\u003Cb>*This is a remote based (work at home) based anywhere in the US.**\u003C/b>\u003Cbr />\u003Cbr />Responsibilities of this Medical Director role are related to Medicare Appeals.\u003Cbr />\u003Cbr />* Direct daily work on part C appeals (both provider and \u003Cspan>\u003Cspan>member/nonparticipating\u003C/span>\u003C/span> providers)\u003Cbr />\u003Cbr />* Provide direct support to appeal nurses; supervision and participation in the Second Look Review (SLR) process\u003Cbr />\u003Cbr />* Provide direct support to the nurses\u003Cbr />\u003Cbr />Provide after hours and weekend coverage on a rotational basis to support 24/7 appeals work\u003Cbr />\u003Cbr />* IRE monitoring and tracking and Utilization Management Strategy support\u003Cbr />\u003Cbr />* Collaborative work with Medicare Quality and Compliance on an ongoing basis\u003Cbr />\u003Cbr />* Develop subject matter expertise on Medicare policy for the enterprise\u003Cbr />\u003Cbr />* Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff\u003Cbr />\u003Cbr />* Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency\u003C/span>\u003C/p>\u003Cp>\u003Cbr />\u003Cbr />\u003Cb>Required Qualifications\u003C/b>\u003C/p>\u003Cp>\u003Cspan>* Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry\u003C/span>\u003Cbr />\u003Cspan> \u003C/span>\u003C/p>\u003Cp>\u003Cspan>* Medical License (MD) or (DO)\u003Cbr />\u003Cbr />* An Active state medical license without encumbrances\u003Cbr />\u003Cbr />* Board Certified in ABMS or AOA Recognized Specialty\u003C/span>\u003C/p>\u003Cp>\u003Cbr />\u003Cbr />\u003Cb>Preferred Qualifications\u003C/b>\u003Cbr />\u003Cspan>* Medical Management - Medicare Complaints, Grievance & Appeals experience.\u003Cbr />\u003Cbr />* Health Plan Experience Highly Preferred\u003C/span>\u003C/p>\u003Cp>\u003C/p>\u003Cp>\u003Cb>Education: \u003C/b>\u003C/p>\u003Cp>MD or DO\u003Cbr />\u003Cbr />\u003Cbr /> \u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">\u003Cb>Pay Range\u003C/b>\u003C/p>\u003Cp style=\"text-align:left\">The typical pay range for this role is:\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>$174,070.00 - $374,920.00\u003Cp style=\"text-align:left\">\u003Cbr />This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. \u003Cbr /> \u003C/p>\u003Cp style=\"text-align:left\">Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">\u003Cb>Great benefits for great people\u003C/b>\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:\u003C/p>\u003Cul>\u003Cli>\u003Cp style=\"text-align:left\">\u003Cb>Affordable medical plan options,\u003C/b> a \u003Cb>401(k) plan \u003C/b>(including matching company contributions), and an \u003Cb>employee stock purchase plan\u003C/b>.\u003C/p>\u003C/li>\u003Cli>\u003Cp style=\"text-align:left\">\u003Cb>No-cost programs for all colleagues \u003C/b>including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.\u003C/p>\u003C/li>\u003Cli>\u003Cp style=\"text-align:left\">\u003Cb>Benefit solutions that address the different needs and preferences of our colleagues\u003C/b> including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.\u003C/p>\u003C/li>\u003C/ul>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">For more information, visit \u003Ca target=\"_blank\" href=\"https://jobs.cvshealth.com/us/en/benefits\">\u003Cspan class=\"WJQ0\">https://jobs.cvshealth.com/us/en/benefits\u003C/span>\u003C/a>\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>We anticipate the application window for this opening will close on: 08/29/2025\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:inherit\">\u003C/p>\u003Cp style=\"text-align:left\">Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.\u003C/p>","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/CT---Work-from-home/Medical-Director---Medicare-Appeals_R0613646",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[721],{"city":8,"region":230,"country":33},"2025-07-29T00:00:00Z","Candidates must possess a Medical License (MD or DO) and an active state medical license without encumbrances. A minimum of two years of experience in a Health Care Delivery System, such as clinical practice or the health care industry, is required. Preferred qualifications include experience in Medical Management, specifically with Medicare Complaints, Grievances, and Appeals, as well as Health Plan experience.","The Medical Director will oversee daily operations for Part C appeals, including both provider and member/nonparticipating provider cases. They will provide direct support and supervision to appeal nurses, participating in the Second Look Review (SLR) process. Responsibilities also include providing after-hours and weekend coverage on a rotational basis, monitoring and tracking IRE, supporting Utilization Management Strategy, and collaborating with Medicare Quality and Compliance. The role involves developing expertise in Medicare policy, educating staff on Medicare policy and appeals, and participating in initiatives to enhance appeals team efficiency and clinical consistency.",{"employment":726,"compensation":728,"experience":729,"visaSponsorship":732,"location":733,"skills":734,"industries":745},{"type":727},{"id":114,"name":115,"description":8},{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":8},{"experienceLevels":730},[731],{"id":581,"name":582,"description":8},{"type":49},{"type":49},[735,736,737,738,739,740,741,742,743,744],"Medicare Appeals","Part C appeals","Provider appeals","Member appeals","Second Look Review (SLR)","IRE monitoring","Utilization Management Strategy","Medicare policy","Clinical practice","Health care industry",[746,747],{"id":61,"name":60},{"id":203,"name":496},{"id":749,"title":750,"alternativeTitles":751,"slug":767,"jobPostId":749,"description":768,"applyUrl":769,"company":66,"companyOption":770,"locations":771,"listingDate":774,"listingSite":107,"isRemote":25,"requirements":775,"responsibilities":776,"status":110,"expiryDate":8,"summary":777},"803deee0-2571-4667-853c-15fb0633df4d","Licensed Practical Nurse (Delaware)",[752,753,754,755,756,757,758,759,760,761,762,763,764,765,766],"Delaware LPN Care Coordinator","LPN Case Manager Delaware","Licensed Practical Nurse - Patient Transition Specialist (DE)","LPN Discharge Planner Delaware","Delaware LPN Health Services Coordinator","LPN Care Navigator Delaware","Licensed Practical Nurse - Complex Care Management (DE)","LPN Post-Acute Care Coordinator (Delaware)","Delaware LPN Patient Advocate","LPN Utilization Reviewer Delaware","Licensed Practical Nurse - Payer Relations (DE)","LPN Community Health Liaison Delaware","Delaware LPN Case Management Specialist","LPN Transition of Care Coordinator (DE)","Licensed Practical Nurse - Home Health Liaison (Delaware)","licensed-practical-nurse-delaware-803deee0-2571-4667-853c-15fb0633df4d","## About the Role\n**Employment Type:** Full time\n\nAt 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 through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.\n\n## Job Summary\n**Hours:** Monday through Friday 8:00 AM to 5:00 PM Eastern Standard Time (EST).\n\nHelp us elevate our member care to a whole new level! Join our Aetna Team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across the country.\n\n## Transition of Care Coach Responsibilities\nThe Transition of Care Coach is responsible for care coordination of our members who are experiencing a significant change in health status which has resulted in the necessity of an emergency department visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered/Licensed RN, the TOC Coach ensures the member experiences a seamless transition to their next care setting and facilitates post-discharge goal attainment by:\n\n- Complete post-discharge questionnaire, which may be market specific.\n- Ensures the member has filled/received their medication(s) and has an understanding on how to take their ordered medications.\n- Benefit education\n- Monitor members in low CM level for alerts or changes in condition to be transitioned back to RN.\n- Complete post discharge call and required assessments (RAP), medication reconciliation (if within scope of practice), fall assessment if fall risk identified.\n- Complete inpatient confinement calls and monitoring for discharge\n- Management of warm transfers form concierge and engagement hub\n- Provides clinical assistance to determine appropriate services and supports due to member’s health needs (including but not limited to: Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports)\n- Evaluation of health and social indicators\n- Identifies and engages barriers to achieving optimal member health.\n- Uses discretion to apply strategies to reduce member risk.\n- Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member’s condition(s) and abilities to self-manage.\n- Coordinates post-discharge meal delivery, assists with securing DME, and helps to ensure timely physician follow-up.\n- Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel.\n\nOur TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality.\n\n## Additional Responsibilities\n- Responsible for completing outreach cadence calls and post-discharge questionnaires within required compliance driven timelines.\n- Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emer","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/DE---Work-from-home/Licensed-Practical-Nurse--Delaware-_R0662786",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[772],{"city":8,"region":8,"country":773},"Germany","2025-07-30T00:00:00Z","Candidates must possess a valid Licensed Practical Nurse (LPN) license in Delaware. Experience in care coordination, particularly with dual-eligible populations and managing complex health and social challenges, is required. Familiarity with Payer/Plan benefits, policies, and procedures is also necessary.","The Licensed Practical Nurse will coordinate care for members transitioning between healthcare settings, ensuring a seamless transition and facilitating post-discharge goal attainment. Responsibilities include completing post-discharge questionnaires and assessments, medication reconciliation, benefit education, and monitoring member health status. The nurse will also manage inpatient confinement calls, coordinate with providers and community resources, identify barriers to optimal health, and assist with securing necessary services like meal delivery and durable medical equipment.",{"employment":778,"compensation":780,"experience":781,"visaSponsorship":784,"location":785,"skills":786,"industries":792},{"type":779},{"id":114,"name":115,"description":8},{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":8},{"experienceLevels":782},[783],{"id":581,"name":582,"description":8},{"type":49},{"type":49},[407,787,788,789,790,595,140,642,791],"Post-discharge follow-up","Medication management","Patient education","Health assessment","Licensed Practical Nurse (LPN)",[793,794,796],{"id":61,"name":60},{"id":203,"name":795},"Pharmaceuticals",{"id":203,"name":204},{"id":798,"title":799,"alternativeTitles":800,"slug":816,"jobPostId":798,"description":817,"applyUrl":818,"company":66,"companyOption":819,"locations":820,"listingDate":823,"listingSite":107,"isRemote":25,"requirements":824,"responsibilities":825,"status":110,"expiryDate":8,"summary":826},"43e4bae7-04cd-4450-9b40-99bcda5a13c8","Utilization Management Clinician Behavioral Health Swing shift/weekend shift -4 days",[801,802,803,804,805,806,807,808,809,810,811,812,813,814,815],"Behavioral Health Utilization Reviewer","Mental Health Case Manager","Substance Abuse Utilization Specialist","Clinical Reviewer - Behavioral Health","Preauthorization Specialist - Mental Health","Behavioral Health Clinician - Utilization Management","Swing Shift Behavioral Health Specialist","Weekend Behavioral Health Utilization Coordinator","LPC Utilization Manager","LCSW Utilization Reviewer","LMFT Utilization Specialist","RN Behavioral Health Utilization Review","Clinical Psychologist Utilization Management","Behavioral Health Benefits Coordinator","Mental Health Service Authorization Specialist","utilization-management-clinician-behavioral-health-swing-shift-weekend-shift-4-days-43e4bae7-04cd-4450-9b40-99bcda5a13c8","## About CVS Health\nAt 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 through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.\n\n## Position Summary\n* **Employment Type:** Full time\n* **Location:** Fully remote in the USA\n* **Schedule:** Saturday and Sunday 10am-8pm MT, Thursday and Friday 3p-1am MT\n* **Requirements:** Must be able to work Weekends and Holidays.\n* **Differential:** 12.5% differential for this shift.\n* **Role:** Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program for preauthorization for mental health services. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus within a call center setting.\n\n## Required Qualifications\n* 3+ years of post clinical licensure experience in behavioral health\n* 3+ years knowledge of mental health and substance abuse disorders\n* Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in the state they reside in (one or more or equivalent is required: LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist or RN)\n* Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties.\n* Must be able to talk on the telephone and type at the same time, this is a queue based job\n\n## Preferred Qualifications\n* Direct clinical experience in a hospital setting or prior Utilization Management experience.\n* Valid California unrestricted independent professional behavioral health clinical license\n\n## Education\n* If RN, Bachelor's degree in nursing required with 3 years of behavioral health experience\n* If BH-licensed, Masters degree in Social Work, Counseling, Psychology required\n\n## Compensation and Benefits\n* **Anticipated Weekly Hours:** 40\n* **Time Type:** Full time\n* **Pay Range:** $54,095.00 - $142,576.00 (This is the base pay range. Actual offer depends on experience, education, geography, etc.)\n* **Bonus/Incentive:** This position is eligible for a CVS Health bonus, commission or short-term incentive program.\n\n## Our People & Benefits\nOur people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\n\n**Great benefits for great people:** We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be.\n\n**In addition to our competitive wages, our great benefits include:**\n* Affordable medical plan options\n* A 401(k) plan (including matching company contributions)\n* An employee stock purchase plan\n* No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.\n* Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.\n\nFor more information, visit the CVS Health careers site.","https://cvshealth.wd1.myworkdayjobs.com/cvs_health_careers/job/UT---Work-from-home/Utilization-Management-Clinician-Behavioral-Health-Swing-shift-weekend-shift--4-days_R0673168",{"id":65,"name":66,"urlSafeSlug":103,"logo":67},[821],{"city":8,"region":822,"country":33},"Utah","2025-08-05T00:00:00Z","Candidates must possess at least 3 years of post-clinical licensure experience in behavioral health and 3 years of knowledge in mental health and substance abuse disorders. A valid, unrestricted independent professional behavioral health clinical license to practice per state regulations is required, such as LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist, or RN. If an RN, a Bachelor's degree in nursing with 3 years of behavioral health experience is necessary. If licensed in behavioral health, a Master's degree in Social Work, Counseling, or Psychology is required. Candidates must also have residential broadband internet speeds of at least 25 mbps download and 3 mbps upload, and be able to talk on the telephone while typing.","The Utilization Management Clinician will utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program for preauthorization of mental health services. They will apply critical thinking and demonstrate knowledge of clinically appropriate treatment, evidence-based care, and clinical practice guidelines for behavioral health and/or medical conditions within a call center setting.",{"employment":827,"compensation":829,"experience":831,"visaSponsorship":834,"location":835,"skills":836,"industries":857},{"type":828},{"id":114,"name":115,"description":8},{"minAnnualSalary":8,"maxAnnualSalary":8,"currency":8,"details":830},"12.5% differential for this shift.",{"experienceLevels":832},[833],{"id":481,"name":482,"description":8},{"type":49},{"type":49},[837,838,839,486,840,841,842,843,844,845,846,847,848,849,850,851,852,853,854,855,856],"Behavioral Health","Mental Health","Substance Abuse Disorders","Preauthorization","Clinical Practice Guidelines","Evidence-Based Care","Critical Thinking","LPC","LMFT","LCSW","LMHC","LCMHC","LICSW","LISW","Clinical Psychologist","RN","Hospital Setting","Residential Broadband","Telephone Communication","Typing",[858,859],{"id":61,"name":60},{"id":203,"name":795},["Reactive",861],{"$ssite-config":862},{"env":863,"name":864,"url":865},"production","nuxt-app","https://jobo.world",["Set"],["ShallowReactive",868],{"company-CVS-Health":-1,"company-jobs-499b17a6-17e7-417f-8b0d-ced45f934fa1-carousel":-1},"/company/CVS-Health",{}]