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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.
$54,095.6 - $116,800Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Position SummaryThe Senior Manager negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts. The Senior Manager will be responsible for contracting and implementing fee for service and some value-based agreements with key physician groups, facilities, and ancillary providers to support commercial, Medicare, and individual exchange networks.
$67,900 - $174,200Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Through the use of care management tools and information/data review, the Case Manager conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
$60,522.8 - $129,600Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Evaluation of Members:-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.
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As part of the Medical Expense Review (MER) team, you will prepare for monthly presentations, and manage both long and short-term projects, working collaboratively with local market leaders to accomplish tasks and goals that will improve the care we give our patients.
$63,300 - $139,200Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
$60,522.8 - $129,600Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating.
$60,522.8 - $129,600Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Required Qualifications :Minimum 3+ years clinical practical experienceMinimum 2+ years Case Management, discharge planning and/or home health care coordination experienceMust have active and unrestricted RN licensure in the state of Texas Preferred Qualifications :Bilingual (English / Spanish)Certified Case Manager Educational Requirements:Associates Degree Required.
$60,522.8 - $129,600Full-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Pharmacy Program Manager acts as a Clinical Pharmacist providing pharmacist support for an interdisciplinary care management team and members under assigned plan sponsors through comprehensive medication reviews, drug information, phone outreach to members and providers, identifying and resolving medication related interventions.
$78,331.5 - $168,700Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
$60,522.8 - $129,600Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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3 years Managed care/utilization review experience preferred. -3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
$54,095.6 - $116,800 a yearFull-timeExpandApply NowActive JobUpdated 28 days ago - UpvoteDownvoteShare Job
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Experienced/career level position responsible for overseeing quality review audits of medical records coded by internal team (CDQA and Sr Analyst CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures.
$67,900 - $149,300 a yearFull-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention Services, and evidence-based practices applicable to this populations highly preferred.
$54,095.6 - $116,800 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Crisis intervention skills preferred managed care/utilization review experience preferred. Managed care/utilization review experience preferred. 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.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. Initiates, coordinates, and own the contracting activities to fulfillment including receipt and processing of contracts and documentation and pre and post signature review of contracts and language modification according to Aetna's established policies.
$75,400 - $174,200 a yearFull-timeExpandApply NowActive JobUpdated 29 days ago
review care manager jobs Title: manager Company: Cvs Health
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