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Most recent job postings at Aetna
via Smart Recruiters Jobs
schedule_type: Full-time
Company Description
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness... lifestyles and offer specialty programs here at
Company Description
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness... lifestyles and offer specialty programs here at Aetna.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Description
Job Description :
JOIN OUR GROWING TEAMAre you tired of bedside nursing?Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers’ Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
POSITION SUMMARY
Responsible for coordinating and facilitating the medical treatment of clients. Clients are primarily from workers comp claims in various stages of recovery. This is a work-from-home position, and the case manager will travel to meet and work with clients, providers and employers, as needed, throughout the rehabilitation process, documenting all activities.
Fundamental Components but not limited to the following:
Requires strong time management skills, ability to multi-task, prioritize tasks and respond to issues in a timely manner. Requires competent use of technology including iPhones, laptops, and Microsoft Office programs including email to complete timely, concise and effective communication the status of the clients.
Manage caseload of clients from a variety of referral sources including verifying the specific reason for each referral, develop and implement a strategy to complete, and document all activities and progress.
Travel to meet clients, providers and employers mostly around the Monroe MI & Toledo Ohio area, up to approximately 75 miles from this area. Must use own car and mileage reimbursement is provided.
Will meet clients to complete assessments, identify medical and vocational barriers, and create strategies towards facilitating the rehab process, including return to work for workers comp clients. Will continually identify barriers and develop strategies to overcome those barriers.
Attend appointments with clients and providers to review medical status and discuss treatment plans options. Compare the recommended treatment plan with clinical protocols and collaborate with the provider to resolve any differences. Will review plan with client and provide educational resources on relevant medical issues.
With workers comp referrals, will meet with employers as needed to determine what is needed for the client to return to work, includes documenting all the physical requirements of the job (Job Analysis) and reviewing the requirements with the providers. Will maintain regular communication with the employer to facilitate return to work.
Detailed information on any significant information is provided to the referral source within 24 hours with summary reports completed on a monthly basis.
Required to complete catastrophic referral training within the first year and manage the occasional catastrophic referrals that are after regular business hours.
Coventry requires Case Managers to be educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management.
Qualifications
BACKGROUND/EXPERIENCE:
3+ years clinical practice experience.
3+ years case management experience with workers compensation, disability, and auto liability preferred.
If no case management experience, 5 years of Home Health Care and/or Hospice care.
Bilingual in Spanish preferred.
Knowledge of laws and regulations governing delivery of rehabilitation services.
Effective communications, organizational, and interpersonal skills.
Ability to work-independently, requires working from home in a safe and secure environment.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
Effective computer skills including navigating multiple systems and keyboarding
EDUCATION
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Prefer any of the following credentials in good standing: CCM, CDMS, COHN, COHN-S, CRRN.
FUNCTIONAL EXPERIENCES
Functional - Nursing/Case Management/1-3 Years
Functional - Nursing/Home Health Care/4-6 Years
Functional - Nursing/Occupational/1-3 Years
Functional - Nursing/Medical-Surgical Care/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
Additional Information
ADDITIONAL JOB INFORMATION
Work Autonomously
No Weekend of Holiday
Meet top doctors of their specialty and learn from them directly
Earn CEU free by attending free seminars and in house training
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
As a Workers’ Compensation Field Case Manager, you will be offered:
• Autonomy
• Productivity incentives
• Monday-Friday schedule
• Reimbursement for mileage, tolls, parking, licensure and certification
· Laptop, iPhone & printer/fax/scanner all in one.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position Show more details...
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness... lifestyles and offer specialty programs here at Aetna.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Description
Job Description :
JOIN OUR GROWING TEAMAre you tired of bedside nursing?Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers’ Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
POSITION SUMMARY
Responsible for coordinating and facilitating the medical treatment of clients. Clients are primarily from workers comp claims in various stages of recovery. This is a work-from-home position, and the case manager will travel to meet and work with clients, providers and employers, as needed, throughout the rehabilitation process, documenting all activities.
Fundamental Components but not limited to the following:
Requires strong time management skills, ability to multi-task, prioritize tasks and respond to issues in a timely manner. Requires competent use of technology including iPhones, laptops, and Microsoft Office programs including email to complete timely, concise and effective communication the status of the clients.
Manage caseload of clients from a variety of referral sources including verifying the specific reason for each referral, develop and implement a strategy to complete, and document all activities and progress.
Travel to meet clients, providers and employers mostly around the Monroe MI & Toledo Ohio area, up to approximately 75 miles from this area. Must use own car and mileage reimbursement is provided.
Will meet clients to complete assessments, identify medical and vocational barriers, and create strategies towards facilitating the rehab process, including return to work for workers comp clients. Will continually identify barriers and develop strategies to overcome those barriers.
Attend appointments with clients and providers to review medical status and discuss treatment plans options. Compare the recommended treatment plan with clinical protocols and collaborate with the provider to resolve any differences. Will review plan with client and provide educational resources on relevant medical issues.
With workers comp referrals, will meet with employers as needed to determine what is needed for the client to return to work, includes documenting all the physical requirements of the job (Job Analysis) and reviewing the requirements with the providers. Will maintain regular communication with the employer to facilitate return to work.
Detailed information on any significant information is provided to the referral source within 24 hours with summary reports completed on a monthly basis.
Required to complete catastrophic referral training within the first year and manage the occasional catastrophic referrals that are after regular business hours.
Coventry requires Case Managers to be educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management.
Qualifications
BACKGROUND/EXPERIENCE:
3+ years clinical practice experience.
3+ years case management experience with workers compensation, disability, and auto liability preferred.
If no case management experience, 5 years of Home Health Care and/or Hospice care.
Bilingual in Spanish preferred.
Knowledge of laws and regulations governing delivery of rehabilitation services.
Effective communications, organizational, and interpersonal skills.
Ability to work-independently, requires working from home in a safe and secure environment.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
Effective computer skills including navigating multiple systems and keyboarding
EDUCATION
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Prefer any of the following credentials in good standing: CCM, CDMS, COHN, COHN-S, CRRN.
FUNCTIONAL EXPERIENCES
Functional - Nursing/Case Management/1-3 Years
Functional - Nursing/Home Health Care/4-6 Years
Functional - Nursing/Occupational/1-3 Years
Functional - Nursing/Medical-Surgical Care/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
Additional Information
ADDITIONAL JOB INFORMATION
Work Autonomously
No Weekend of Holiday
Meet top doctors of their specialty and learn from them directly
Earn CEU free by attending free seminars and in house training
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
As a Workers’ Compensation Field Case Manager, you will be offered:
• Autonomy
• Productivity incentives
• Monday-Friday schedule
• Reimbursement for mileage, tolls, parking, licensure and certification
· Laptop, iPhone & printer/fax/scanner all in one.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position Show more details...
via CareerBuilder
posted_at: 1 day agoschedule_type: Full-time
Job Description
This is a remote position for anywhere in the US...
Aetna Medicare is seeking a Software Quality Assurance Manager to join our exciting team. We build internal healthcare insurance related applications that allow our business users to collaborate online to complete crucial tasks for Aetna. We also qa/validate various business data elements such as claims, formulary data, and others to ensure accuracy in the process. This position
Job Description
This is a remote position for anywhere in the US...
Aetna Medicare is seeking a Software Quality Assurance Manager to join our exciting team. We build internal healthcare insurance related applications that allow our business users to collaborate online to complete crucial tasks for Aetna. We also qa/validate various business data elements such as claims, formulary data, and others to ensure accuracy in the process. This position will be a great addition to our already talented team which consists of UI/UX developers, database engineers, business analysts, quality analysts, project managers and others.
The position could work remotely anywhere in the US if approved.
Prepares and executes comprehensive test plans and test scripts to ensure quality and accuracy is maintained.
Verifies that system functions according to user requirements and conforms to established guidelines.
Completes comprehensive test conditions and test cases for system enhancements and new business products and processes.
Follows standardized best practices for documenting and executing moderately complex to complex test plans.
Validates test results, documents discrepancies, and follows through with resolutions to ensure all issues are resolved.
Reports progress of problem resolution to management.
Suggests modifications to conform to standards.
Provides training and guidance if needed.
Performs other duties as required.
Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 162,700
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Proficient in SQL
Experience in Quality Assurance Systems Application
Strong skills in critical thinking, analysis, and documentation
Excellent verbal and written communication skills.
Demonstrated proficiency with personal computer, keyboard navigation skills and familiarity with MS Office Suite applications.
.
Preferred Qualifications
5 + years experience in a quality assurance and/or a testing environment
Advanced knowledge of Healthcare, specifically Medicare.
Education
Bachelor's Degree or equivalent experience
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
This is a remote position for anywhere in the US...
Aetna Medicare is seeking a Software Quality Assurance Manager to join our exciting team. We build internal healthcare insurance related applications that allow our business users to collaborate online to complete crucial tasks for Aetna. We also qa/validate various business data elements such as claims, formulary data, and others to ensure accuracy in the process. This position will be a great addition to our already talented team which consists of UI/UX developers, database engineers, business analysts, quality analysts, project managers and others.
The position could work remotely anywhere in the US if approved.
Prepares and executes comprehensive test plans and test scripts to ensure quality and accuracy is maintained.
Verifies that system functions according to user requirements and conforms to established guidelines.
Completes comprehensive test conditions and test cases for system enhancements and new business products and processes.
Follows standardized best practices for documenting and executing moderately complex to complex test plans.
Validates test results, documents discrepancies, and follows through with resolutions to ensure all issues are resolved.
Reports progress of problem resolution to management.
Suggests modifications to conform to standards.
Provides training and guidance if needed.
Performs other duties as required.
Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 162,700
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Proficient in SQL
Experience in Quality Assurance Systems Application
Strong skills in critical thinking, analysis, and documentation
Excellent verbal and written communication skills.
Demonstrated proficiency with personal computer, keyboard navigation skills and familiarity with MS Office Suite applications.
.
Preferred Qualifications
5 + years experience in a quality assurance and/or a testing environment
Advanced knowledge of Healthcare, specifically Medicare.
Education
Bachelor's Degree or equivalent experience
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
via CareerBuilder
posted_at: 1 day agoschedule_type: Full-time
Job Description
Qualifying candidates may be eligible for a sign on bonus of up to $5000...
This is work from home position with up to 50-60% travel throughout Southern Illinois. Candidates will not be required to travel more than one hour from their location.
Schedule is within the hours of 8am - 8pm
Care coordination involves assessing the child's needs and developing and implementing a plan to meet those needs. Care coordination can involve
Job Description
Qualifying candidates may be eligible for a sign on bonus of up to $5000...
This is work from home position with up to 50-60% travel throughout Southern Illinois. Candidates will not be required to travel more than one hour from their location.
Schedule is within the hours of 8am - 8pm
Care coordination involves assessing the child's needs and developing and implementing a plan to meet those needs. Care coordination can involve setting up a schedule for the child's medications, treatments, and health care provider visits or assistance in finding local services or providers. The Comprehensive Care Coordinator is responsible for providing the coordination of all services to children and families designated as a child living with special needs or youth in care facilitating Family Support Meetings . The Comprehensive Care Coordinator will coordinate with Family, Clinical services, treatment team and Supervisors on the development, planning and implantation of therapeutic services as they relate to the individual child's behavioral and emotional health. Essential Duties and Responsibilities: Care Planning and coordination of needs • Provides services consistent with the guiding principles of the agency's philosophy of strength based, family focused, needs driven and culturally competent care. • Completes assessments, formulate and implement an overall comprehensive care plan for each child and family, consistent with the needs of the child and family team and the plan. • Gather information and develop a comprehensive care plan that addresses risk factors, psychosocial history, substance abuse history, mental health history, community functioning, performance outcomes, strengths, challenges, goals, interventions, and discharge planning according to the programs mission. • Facilitates and coordinates Family Support Meetings . • Identify potential problems and crisis areas, prioritize according to seriousness and create an effective and well specified safety plan. • Collaborate with family, clinical team members, county workers, external providers, and natural supports for case conceptualization, assessment, and treatment planning.
Pay Range
The typical pay range for this role is:
Minimum: 28.25
Maximum: 60.50
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• Active and unrestricted Clinical Behavioral Health license in the state of IL (Ex. LCSW, LCPC , LMFT)
• Minimum 2 years of supervised clinical experience in human services field
• Minimum 2 year of experience working with children with Behavioral Health needs
• Willing and able to travel up to 50-60 % of their time using their own vehicle to meet members face to face throughout Southern Illinois. Candidates will not be required to travel for more than one hour from their location.
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
Previous Managed Care Organization experience
Education
Master's Degree in Behavioral Health/Mental Health/Social Service/Human Service field required.
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
Qualifying candidates may be eligible for a sign on bonus of up to $5000...
This is work from home position with up to 50-60% travel throughout Southern Illinois. Candidates will not be required to travel more than one hour from their location.
Schedule is within the hours of 8am - 8pm
Care coordination involves assessing the child's needs and developing and implementing a plan to meet those needs. Care coordination can involve setting up a schedule for the child's medications, treatments, and health care provider visits or assistance in finding local services or providers. The Comprehensive Care Coordinator is responsible for providing the coordination of all services to children and families designated as a child living with special needs or youth in care facilitating Family Support Meetings . The Comprehensive Care Coordinator will coordinate with Family, Clinical services, treatment team and Supervisors on the development, planning and implantation of therapeutic services as they relate to the individual child's behavioral and emotional health. Essential Duties and Responsibilities: Care Planning and coordination of needs • Provides services consistent with the guiding principles of the agency's philosophy of strength based, family focused, needs driven and culturally competent care. • Completes assessments, formulate and implement an overall comprehensive care plan for each child and family, consistent with the needs of the child and family team and the plan. • Gather information and develop a comprehensive care plan that addresses risk factors, psychosocial history, substance abuse history, mental health history, community functioning, performance outcomes, strengths, challenges, goals, interventions, and discharge planning according to the programs mission. • Facilitates and coordinates Family Support Meetings . • Identify potential problems and crisis areas, prioritize according to seriousness and create an effective and well specified safety plan. • Collaborate with family, clinical team members, county workers, external providers, and natural supports for case conceptualization, assessment, and treatment planning.
Pay Range
The typical pay range for this role is:
Minimum: 28.25
Maximum: 60.50
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• Active and unrestricted Clinical Behavioral Health license in the state of IL (Ex. LCSW, LCPC , LMFT)
• Minimum 2 years of supervised clinical experience in human services field
• Minimum 2 year of experience working with children with Behavioral Health needs
• Willing and able to travel up to 50-60 % of their time using their own vehicle to meet members face to face throughout Southern Illinois. Candidates will not be required to travel for more than one hour from their location.
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
Previous Managed Care Organization experience
Education
Master's Degree in Behavioral Health/Mental Health/Social Service/Human Service field required.
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
via CareerBuilder
posted_at: 1 day agoschedule_type: Full-time
Job Description
This is telework position with up to 80% travel in Jefferson region ( Jefferson County). Candidate may reside in or adjacent counties...
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality
Job Description
This is telework position with up to 80% travel in Jefferson region ( Jefferson County). Candidate may reside in or adjacent counties...
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Oversight and Management of clinical team processes including the organization and development of high performing teams.
Care coordination with community partners to ensure successful reduction of risk of placement in an acute psychiatric facility, long term residential facility or disruption of placement.
Responsibilities include:
• Reinforces clinical philosophy, programs, policies and procedures.
• Communicates strategic plan and specific tactics to meet plan.
• Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Accountable for meeting the financial, operational and quality objectives of the unit.
• May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position
• Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.
• Develop, initiate, monitor and communicate performance expectations.
• May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
Pay Range
The typical pay range for this role is:
Minimum: 19.50
Maximum: 40.10
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
2 years' experience in behavioral health, social services, or human services field.
• 1 year experience with MS Office Suite applications, including Word and Excel.
• Willing and able to travel 80-90% to meet members face to face in Jefferson region ( Jefferson County and surrounding areas.).
• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required, as we are serving the needs of children and families that may require working after school, after work, etc.
Preferred Qualifications
Knowledge of growth and developmental milestones.
• Care management experience
• Discharge planning experience
• Managed Care experience
• 6 months of Experience and detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, or evidence-based practices applicable to the Kentucky SKY populations is strongly preferred.
Education
Minimum of a Bachelor's degree or a non-licensed master level clinician is required with either degree being in behavioral health or a relevant human services field of study (social work, psychology, marriage and family therapy, counseling) required.
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
This is telework position with up to 80% travel in Jefferson region ( Jefferson County). Candidate may reside in or adjacent counties...
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Oversight and Management of clinical team processes including the organization and development of high performing teams.
Care coordination with community partners to ensure successful reduction of risk of placement in an acute psychiatric facility, long term residential facility or disruption of placement.
Responsibilities include:
• Reinforces clinical philosophy, programs, policies and procedures.
• Communicates strategic plan and specific tactics to meet plan.
• Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Accountable for meeting the financial, operational and quality objectives of the unit.
• May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position
• Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.
• Develop, initiate, monitor and communicate performance expectations.
• May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
Pay Range
The typical pay range for this role is:
Minimum: 19.50
Maximum: 40.10
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
2 years' experience in behavioral health, social services, or human services field.
• 1 year experience with MS Office Suite applications, including Word and Excel.
• Willing and able to travel 80-90% to meet members face to face in Jefferson region ( Jefferson County and surrounding areas.).
• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required, as we are serving the needs of children and families that may require working after school, after work, etc.
Preferred Qualifications
Knowledge of growth and developmental milestones.
• Care management experience
• Discharge planning experience
• Managed Care experience
• 6 months of Experience and detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, or evidence-based practices applicable to the Kentucky SKY populations is strongly preferred.
Education
Minimum of a Bachelor's degree or a non-licensed master level clinician is required with either degree being in behavioral health or a relevant human services field of study (social work, psychology, marriage and family therapy, counseling) required.
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
via Car-Kendra.com
posted_at: 17 days agoschedule_type: Full-timesalary: 21–31 an hourwork_from_home: 1
Health is the entirety. At CVS health, we are committed to growing access, reducing fees and enhancing the fine of care. Hundreds of thousands of times an afternoon, we assist humans on their journey to better health, from advising on prescriptions to assisting manipulate persistent and special situations. Due to the fact we're found in such a lot of moments, large and small, we play an active and supportive function in shaping the destiny of healthcare.
Health is the entirety. At CVS health, we are committed to growing access, reducing fees and enhancing the fine of care. Hundreds of thousands of times an afternoon, we assist humans on their journey to better health, from advising on prescriptions to assisting manipulate persistent and special situations. Due to the fact we're found in such a lot of moments, large and small, we play an active and supportive function in shaping the destiny of healthcare. Telepharmacy Technicians are at the vanguard of our reason, providing compassionate care to our patients every day. Cvs Careers Cvs Remote Jobs Aetna Careers Work From Home Cvs Aetna Careers Work From Home Aetna Rn Jobs Cvs Aetna Work From Home Salary.
Show more details...
via Indeed
schedule_type: Full-timesalary: 158K–357K a year
The AVP, Client Services is responsible for leading the Aetna Pharmacy Benefit, Clinical, Quality, and Client Operations unit spanning 251 colleagues across Commercial, Exchange, Medicare, and Medicaid lines of business. Aetna Pharmacy Benefit, Clinical, and Quality Operations implements and maintains client pharmacy benefits plans including all clinical and specialty components of the plans... Client Operations provides member experience, operational
The AVP, Client Services is responsible for leading the Aetna Pharmacy Benefit, Clinical, Quality, and Client Operations unit spanning 251 colleagues across Commercial, Exchange, Medicare, and Medicaid lines of business. Aetna Pharmacy Benefit, Clinical, and Quality Operations implements and maintains client pharmacy benefits plans including all clinical and specialty components of the plans... Client Operations provides member experience, operational reporting, Annual Enrollment Program (AEP), Coordination of Benefits (COB), eligibility, and claims monitoring services to the Aetna business. The unit services 27M members and generates +$30B in revenue.
Key responsibilities include:
• Developing and executing on the pharmacy benefit, clinical, quality and client operations strategies and provides short-term to med-term tactical direction and operations oversite to the unit.
• Setting plans, policies, and goals for the unit and is responsible for the financial performance of the unit ($31M budget) including capital investments and reduction of financial client payments due to pharmacy benefit configuration issues.
• Taking strategic and operational direction from the Vice President of Client Services.
• Partnering with senior leaders across Sales, Account Management, IT, and clients to ensure client service expectations are achieved. The AVP partners with Product to design, build, and rollout new pharmacy products to clients.
• Developing and executing on the pharmacy benefit, clinical, quality, and client operations strategies to meet Aetna’s pharmacy benefit objectives.
• Providing short-term to med-term leadership direction and operations oversite to the unit.
• Leading the delivery of Aetna pharmacy benefits and clinical operations services across Commercial, Exchange, Medicare, and Medicaid lines of business.
• Setting plans, policies, and goals for the unit.
• Managing the financial performance of the unit including capital investments and reduction in financial payments to clients due to pharmacy benefit configuration issues.
Pay Range
The typical pay range for this role is:
Minimum: 157,800
Maximum: 356,800
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• 15 years of Healthcare experience, or leading in a complex industry, with matrix leadership
• 10+ years of progressive leadership, leading leaders through KPIs
• Prior experience managing a budget, staffing, and resource management
• Strong communication, both verbal and written, with executive presence
• Influencing across functions and all levels of an organization
• 8 years of managing client relationships
• Prior experience leading large integrated project plans, and overall change management across the enterprise
Preferred Qualifications
• Advanced Degree
• Knowledge of Benefits and Clinical Operations including how benefits and clinical programs are designed/ implemented
• PBM Experience
• AGILE Development Methods
Education
• Bachelor's Degree
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
Key responsibilities include:
• Developing and executing on the pharmacy benefit, clinical, quality and client operations strategies and provides short-term to med-term tactical direction and operations oversite to the unit.
• Setting plans, policies, and goals for the unit and is responsible for the financial performance of the unit ($31M budget) including capital investments and reduction of financial client payments due to pharmacy benefit configuration issues.
• Taking strategic and operational direction from the Vice President of Client Services.
• Partnering with senior leaders across Sales, Account Management, IT, and clients to ensure client service expectations are achieved. The AVP partners with Product to design, build, and rollout new pharmacy products to clients.
• Developing and executing on the pharmacy benefit, clinical, quality, and client operations strategies to meet Aetna’s pharmacy benefit objectives.
• Providing short-term to med-term leadership direction and operations oversite to the unit.
• Leading the delivery of Aetna pharmacy benefits and clinical operations services across Commercial, Exchange, Medicare, and Medicaid lines of business.
• Setting plans, policies, and goals for the unit.
• Managing the financial performance of the unit including capital investments and reduction in financial payments to clients due to pharmacy benefit configuration issues.
Pay Range
The typical pay range for this role is:
Minimum: 157,800
Maximum: 356,800
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• 15 years of Healthcare experience, or leading in a complex industry, with matrix leadership
• 10+ years of progressive leadership, leading leaders through KPIs
• Prior experience managing a budget, staffing, and resource management
• Strong communication, both verbal and written, with executive presence
• Influencing across functions and all levels of an organization
• 8 years of managing client relationships
• Prior experience leading large integrated project plans, and overall change management across the enterprise
Preferred Qualifications
• Advanced Degree
• Knowledge of Benefits and Clinical Operations including how benefits and clinical programs are designed/ implemented
• PBM Experience
• AGILE Development Methods
Education
• Bachelor's Degree
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
via CareerBuilder
posted_at: 1 day agoschedule_type: Full-time
Job Description
The Health Equity team is dedicated to ensuring that all consumers and communities have equal opportunity to achieve their optimal health status...
In this highly visible role, you will use your project management skills to lead multiple projects to standardize and increase collection of health equity data for members, customers and providers. You will have the opportunity to work with a wide variety of stakeholders from across the
Job Description
The Health Equity team is dedicated to ensuring that all consumers and communities have equal opportunity to achieve their optimal health status...
In this highly visible role, you will use your project management skills to lead multiple projects to standardize and increase collection of health equity data for members, customers and providers. You will have the opportunity to work with a wide variety of stakeholders from across the enterprise, gain insight into existing business processes and operational workflows, and identify opportunities to promote health equity and improve care quality and the consumer experience.
Duties may include:
• Providing direction to project teams and handling all aspects of project planning, requirements gathering, scheduling and work planning, communications, and issue resolution
• Creating and implementing a process to inventory existing systems and process that collect and store demographic
• Leading key stakeholder interviews and focus groups to gather feedback and input on proposed data collection processes
• Leading workgroups with multi-disciplinary teams to establish best practices for data collection in care delivery settings, digital systems of engagement, and customer service workflows
• Collaborating with IT and digital teams to establish and execute on roadmap for implementing updates to systems
Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 227,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• 8+ years of experience with project management within managed healthcare or a healthcare setting
• Demonstrated experience managing complex projects and programs
• Ability to operate effectively in a large, complex, and diverse global organization
• Excellent communication skills and ability to present to a wide range of stakeholders
• Proficiency in project management tools, Microsoft Word, Excel, PowerPoint, Visio and Project
Preferred Qualifications
• Project Management experience in the healthcare industry
• Functional understanding of the Agile methodology
• Project Management Professional (PMP) certification
• Interest in health equity, public health, community health, civil rights, social determinants of health
Education
Bachelor's Degree
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
The Health Equity team is dedicated to ensuring that all consumers and communities have equal opportunity to achieve their optimal health status...
In this highly visible role, you will use your project management skills to lead multiple projects to standardize and increase collection of health equity data for members, customers and providers. You will have the opportunity to work with a wide variety of stakeholders from across the enterprise, gain insight into existing business processes and operational workflows, and identify opportunities to promote health equity and improve care quality and the consumer experience.
Duties may include:
• Providing direction to project teams and handling all aspects of project planning, requirements gathering, scheduling and work planning, communications, and issue resolution
• Creating and implementing a process to inventory existing systems and process that collect and store demographic
• Leading key stakeholder interviews and focus groups to gather feedback and input on proposed data collection processes
• Leading workgroups with multi-disciplinary teams to establish best practices for data collection in care delivery settings, digital systems of engagement, and customer service workflows
• Collaborating with IT and digital teams to establish and execute on roadmap for implementing updates to systems
Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 227,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• 8+ years of experience with project management within managed healthcare or a healthcare setting
• Demonstrated experience managing complex projects and programs
• Ability to operate effectively in a large, complex, and diverse global organization
• Excellent communication skills and ability to present to a wide range of stakeholders
• Proficiency in project management tools, Microsoft Word, Excel, PowerPoint, Visio and Project
Preferred Qualifications
• Project Management experience in the healthcare industry
• Functional understanding of the Agile methodology
• Project Management Professional (PMP) certification
• Interest in health equity, public health, community health, civil rights, social determinants of health
Education
Bachelor's Degree
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
via CareerBuilder
posted_at: 18 days agoschedule_type: Full-time
Job Description
This position is responsible for recruitment of quality dental networks, providing access and affordability for Aetna Dental Commercial and Medicare clients and members. Utilizing a remote, but mobile work environment, the position additionally fosters growth of managed care contracted networks, while enhancing the profitability of Aetna...
Key Responsibilities
• Researches dental providers/offices utilizing systems to forecast,
Job Description
This position is responsible for recruitment of quality dental networks, providing access and affordability for Aetna Dental Commercial and Medicare clients and members. Utilizing a remote, but mobile work environment, the position additionally fosters growth of managed care contracted networks, while enhancing the profitability of Aetna...
Key Responsibilities
• Researches dental providers/offices utilizing systems to forecast, predict and prepare for recruitment communication, to ensure a positive provider experience and instill confidence in the Aetna brand.
• Strategically identifies, recruits, negotiates, and contracts with dental providers in a geographic area within established guidelines and timelines to meet network goals. Includes all types of communications, including in-person/ground campaigning.
• Develops and builds strong business relationships with dental office personnel, not limited to the dentist, office manager, or insurance coordinator.
• Develops recruitment strategy and executes recruitment efforts to support existing and prospective client needs.
• Ensures paperwork is completed accurately and timely, to comply with state regulations.
• Tracks assigned duties and activities using appropriate company resources (Salesforce/CRM, Avaya phone system, etc.)
• Assists with other projects as assigned.
Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 100,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• 0-3 years of relevant work experience is required
• Strong written and oral communication skills
• Strong negotiation expertise
• Adept at critical and independent thinking
• Proficient in the use of Microsoft applications including manipulation and analysis of data via Excel
• Time management and organization skills
• Ability to analyze situations, determine points of relevance and proper course of actions
• Agility and flexibility towards changing priorities
Preferred Qualifications
• 5-8 years of relevant work experience is preferred
• Knowledge of ADA/CDT codes and general dental terminology is preferred
• Health/Dental insurance knowledge is preferred
• Sales experience is preferred
• Exceptional presentation skills/experience preferred
Education
Bachelor's Degree or equivalent combination of education and experience.
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
This position is responsible for recruitment of quality dental networks, providing access and affordability for Aetna Dental Commercial and Medicare clients and members. Utilizing a remote, but mobile work environment, the position additionally fosters growth of managed care contracted networks, while enhancing the profitability of Aetna...
Key Responsibilities
• Researches dental providers/offices utilizing systems to forecast, predict and prepare for recruitment communication, to ensure a positive provider experience and instill confidence in the Aetna brand.
• Strategically identifies, recruits, negotiates, and contracts with dental providers in a geographic area within established guidelines and timelines to meet network goals. Includes all types of communications, including in-person/ground campaigning.
• Develops and builds strong business relationships with dental office personnel, not limited to the dentist, office manager, or insurance coordinator.
• Develops recruitment strategy and executes recruitment efforts to support existing and prospective client needs.
• Ensures paperwork is completed accurately and timely, to comply with state regulations.
• Tracks assigned duties and activities using appropriate company resources (Salesforce/CRM, Avaya phone system, etc.)
• Assists with other projects as assigned.
Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 100,000
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
• 0-3 years of relevant work experience is required
• Strong written and oral communication skills
• Strong negotiation expertise
• Adept at critical and independent thinking
• Proficient in the use of Microsoft applications including manipulation and analysis of data via Excel
• Time management and organization skills
• Ability to analyze situations, determine points of relevance and proper course of actions
• Agility and flexibility towards changing priorities
Preferred Qualifications
• 5-8 years of relevant work experience is preferred
• Knowledge of ADA/CDT codes and general dental terminology is preferred
• Health/Dental insurance knowledge is preferred
• Sales experience is preferred
• Exceptional presentation skills/experience preferred
Education
Bachelor's Degree or equivalent combination of education and experience.
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
via CareerBuilder
posted_at: 11 days agoschedule_type: Full-time
Job Description This position will be a full-time telework anywhere in the United States. Schedule is Monday-Friday, standard business hours. No nights, no weekends and no holidays. No travel. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider... coordination/collaboration, and coordination of psychosocial
Job Description This position will be a full-time telework anywhere in the United States. Schedule is Monday-Friday, standard business hours. No nights, no weekends and no holidays. No travel. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider... coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
• Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes.
• Provide telephone triage and crisis intervention.
• Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.
• Interact with Physician Advisors to discuss clinical questions and concerns regarding specific cases.
• Participate in QI activities including data collection, tracking, and analysis. Telephonic clinical case management with Medicare population.
• Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs.
• Completes a Comprehensive Assessment and Plan of care.
• Will document in clinical systems to support legacy Aetna and Coventry membership.
• Provides BH consultation and collaboration with Aetna partners.
• Active participation in clinical treatment rounds.
• Active participation in team activities focused on program development. Innovative thinking expected.
Pay Range The typical pay range for this role is:
• 3+ years of clinical experience required
• 2+ years of behavioral health or DSNP experience
• RN (current and unrestricted license in state where resides)
Preferred Qualifications
• 2+ years of managed care experience highly preferred
• 2+ years of case management experience
• DSNP experience preferred
• Discharge planning experience
• Utilization review, prior authorization, concurrent review, appeals experience
• Advanced crisis intervention skills
• CCM preferred
Education Associates or bachelors degree in nursing required Business Overview Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
SDL2017 Show more details...
• Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes.
• Provide telephone triage and crisis intervention.
• Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.
• Interact with Physician Advisors to discuss clinical questions and concerns regarding specific cases.
• Participate in QI activities including data collection, tracking, and analysis. Telephonic clinical case management with Medicare population.
• Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs.
• Completes a Comprehensive Assessment and Plan of care.
• Will document in clinical systems to support legacy Aetna and Coventry membership.
• Provides BH consultation and collaboration with Aetna partners.
• Active participation in clinical treatment rounds.
• Active participation in team activities focused on program development. Innovative thinking expected.
Pay Range The typical pay range for this role is:
• 3+ years of clinical experience required
• 2+ years of behavioral health or DSNP experience
• RN (current and unrestricted license in state where resides)
Preferred Qualifications
• 2+ years of managed care experience highly preferred
• 2+ years of case management experience
• DSNP experience preferred
• Discharge planning experience
• Utilization review, prior authorization, concurrent review, appeals experience
• Advanced crisis intervention skills
• CCM preferred
Education Associates or bachelors degree in nursing required Business Overview Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
SDL2017 Show more details...
via CareerBuilder
posted_at: 19 days agoschedule_type: Full-time
Job Description
Essential Qualifications and Functions: Candidates will provide plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. Meritain's proprietary system provides a benefit solution for customized benefit plans. Plan Builders must possess an analytical system coding ability to translate plan benefits into system data... coding. The setup must also align for exporting in formats
Job Description
Essential Qualifications and Functions: Candidates will provide plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. Meritain's proprietary system provides a benefit solution for customized benefit plans. Plan Builders must possess an analytical system coding ability to translate plan benefits into system data... coding. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.
• Provides plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.
• Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans rather than standard offerings.
• Participate and engage in discussion with Clients related to benefit interpretation. Advising on State and Federal Mandates as well as system capabilities.
• Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.
• Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients.
• Reviews benefit provisions to ensure compliance with state and federal mandates. Evaluation process may also include assessment of summary plan descriptions and other related documents prepared internally or externally by clients.
• Uses business knowledge and experience to make plan design and processing recommendations when working with Clients.
• Evaluates impact of client requested exceptions and develops reasonable alternatives to satisfy client's needs while minimizing impact on Meritain's system and operations; Identifies, communicates and tracks cost sensitive items not included as part of the standard process and highlights them for consideration in the determination of rate adjustments or renewal activity.
• Collaborates on review, analysis and development of recommendations for the design of complex account and benefit structures based on customers' objectives and Meritain's system.
• Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.
• Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)
• Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting.
Pay Range
The typical pay range for this role is:
Minimum: 40,560
Maximum: 83,400
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Knowledge of:
• Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)
• Experienced with various data systems (DOS systems a plus)
Skill In:
• Salesforce
• Medical Terminology
Ability To:
• The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits.
• Be highly organized and able to quickly prioritize multiple assignments with high quality results.
• Should have good communication skills with the ability to express complex concepts in a clear and concise manner.
• Should have a high attention to detail and accuracy while focusing on overall project deliverables.
• Should have the ability to remain flexible yet focused during stressful situations.
• Should possess good analytical and problem solving
skills.
• Should be comfortable multi-tasking, they will be working on more than one client at a time
Preferred Qualifications
Knowledge of:
• Citrix, Outlook, Microsoft Teams Skill in:
• System Programming, Excel Ability To:
• Work independently as well as a group setting.
• Adapts well to change.
The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits.
• This person should be highly organized and able to quickly prioritize multiple assignments with high quality results.
• This person should have good communication skills with the ability to express complex concepts in a clear and concise manner.
• This person should have a high attention to detail and accuracy while focusing on overall project deliverables.
• This person should have the ability to remain flexible yet focused during stressful situations.
• This person should possess good analytical and problem solving skills.
Education
High School Diploma Required
5 years healthcare industry experience with benefits
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
Essential Qualifications and Functions: Candidates will provide plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. Meritain's proprietary system provides a benefit solution for customized benefit plans. Plan Builders must possess an analytical system coding ability to translate plan benefits into system data... coding. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.
• Provides plan benefit review, interpretation and systematic setup essential to the processing of our claims adjudication system. The setup must also align for exporting in formats used for online viewing and processing related to Customer Service, Enrollment, Billing and Reporting in support of internal and external partners.
• Ability to utilize Meritain's proprietary system for analytical coding of detailed customized plans rather than standard offerings.
• Participate and engage in discussion with Clients related to benefit interpretation. Advising on State and Federal Mandates as well as system capabilities.
• Facilitating client facing review of plan setup walking through all benefits to assure alignment of benefit interpretation.
• Consult and advise internal stakeholders on complex benefit administration. Advising on options to minimize manual processing and disruption for the Clients.
• Reviews benefit provisions to ensure compliance with state and federal mandates. Evaluation process may also include assessment of summary plan descriptions and other related documents prepared internally or externally by clients.
• Uses business knowledge and experience to make plan design and processing recommendations when working with Clients.
• Evaluates impact of client requested exceptions and develops reasonable alternatives to satisfy client's needs while minimizing impact on Meritain's system and operations; Identifies, communicates and tracks cost sensitive items not included as part of the standard process and highlights them for consideration in the determination of rate adjustments or renewal activity.
• Collaborates on review, analysis and development of recommendations for the design of complex account and benefit structures based on customers' objectives and Meritain's system.
• Executes system setup and mapping of client level benefits to align with industry coding (ICD 10, Place of service, Healthcare Reform, etc.), this is similar to entry level IT programming.
• Solicits and assesses internal and external customer feedback to enhance continuous quality improvement on the implementation process (ie. System tools, resources, etc.)
• Demonstrates Salesforce proficiency and understanding for cross functional communication and executive level status reporting.
Pay Range
The typical pay range for this role is:
Minimum: 40,560
Maximum: 83,400
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Knowledge of:
• Healthcare industry experience (Customer Service, Claims, and or Plan Build preferred)
• Experienced with various data systems (DOS systems a plus)
Skill In:
• Salesforce
• Medical Terminology
Ability To:
• The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits.
• Be highly organized and able to quickly prioritize multiple assignments with high quality results.
• Should have good communication skills with the ability to express complex concepts in a clear and concise manner.
• Should have a high attention to detail and accuracy while focusing on overall project deliverables.
• Should have the ability to remain flexible yet focused during stressful situations.
• Should possess good analytical and problem solving
skills.
• Should be comfortable multi-tasking, they will be working on more than one client at a time
Preferred Qualifications
Knowledge of:
• Citrix, Outlook, Microsoft Teams Skill in:
• System Programming, Excel Ability To:
• Work independently as well as a group setting.
• Adapts well to change.
The person placed in this role will have an opportunity to work directly with internal and external partners to translate client intent to systematic administration of their plan benefits.
• This person should be highly organized and able to quickly prioritize multiple assignments with high quality results.
• This person should have good communication skills with the ability to express complex concepts in a clear and concise manner.
• This person should have a high attention to detail and accuracy while focusing on overall project deliverables.
• This person should have the ability to remain flexible yet focused during stressful situations.
• This person should possess good analytical and problem solving skills.
Education
High School Diploma Required
5 years healthcare industry experience with benefits
Business Overview
Bring 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 by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities Show more details...
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