We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Join a high-performing actuarial team supporting CVS Health and Aetna's exciting and growing Medicaid business. Support CVS Health's financial integrity by leading actuarial forecasting with sound practices to meet the business needs and ensure reasonable actuarial projections. A Brief Overview The primary focus of this director role will be leading actuarial support for the financial forecast modeling of the Medicaid line of business with a secondary focus on trend analysis & development. This role will primarily provide oversight and leadership of activities related to forecasting with a secondary focus on trend normalization and projection. Fundamental Components Primary Role (70% time): Lead budget and forecast storytelling for the Medicaid business. Oversee forecast model development and improvement, and support plan actuaries in understanding forecast projections. Drive forecast related analysis including development of key assumptions, evaluation of financial experience and trend drivers. Review budget and forecast from a business perspective and ensure sound actuarial projections. Identify and support process improvement through automation and process simplification; assure timely and accurate deliverables. Manage high visibility and complex projects. Allocate and align resources. Se

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members. Aetna Better Health of Maryland is seeking an experience leader with vast operational knowledge of Medicaid for its state-wide managed Medicaid business in the role of Chief Operations Officer (COO). The COO role will be strategic and committed to developing colleagues as well as relentlessly pursuing change that is best for the organization and its customers. The COO role will collaborate with the CEO to develop the strategic vision of the Health Plan, policies & procedures, and operational objectives including leading RFP readiness efforts. The COO will oversee high level strategic and operational activities of various plan functional areas which include traditional service operations (Claims, Provider Services, Information Technology, Grievance & Appeals and Member Services) as well as Medical Management (Quality, Netw

Become a part of our caring community The Director, HR Business Partner leads the people agenda for Humana Healthy Horizons by aligning talent strategy with business strategy and converting business priorities into organizational, leadership, workforce, talent, and culture outcomes. The role is accountable for enabling performance across both the run the business and grow the business agendas. This includes ensuring the Medicaid organization has the workforce capacity, leadership depth, organizational capability, and talent strategies required to deliver current commitments, compete for new business, implement awarded business, and scale successfully. The Director serves as a trusted accountability partner to senior leaders, shapes business decisions through workforce and organizational insight, represents the voice of the business across HR, and orchestrates integrated support from HR Centers of Excellence. The role maintains disciplined ownership of assessment, strategy, execution, and measurable outcomes rather than defaulting to advisory or transactional HR delivery. Primary Responsibilities and Accountabilities 1. Business Strategy and Growth Own translation of business strategy into workforce, leadership, talent, culture, and organizational strategies that enable current business performance and future growth. Assess business priorities, growth opportunities, operating challenges, and organizational risks to determine the people and organizational actions required to achieve business objectives. Establish and execute integrated plans that support market performance, business expansion, procurement activity, awarded business, implementation, and long-term scalability. Ensure workforce and organizational implications are identified, tested, and addressed as strategic choices and growth opportunities

Become a part of our caring community The Senior HR Business Partner will lead the people management agenda aligned to Medicaid RFP/RFI/RFA responses. Their work will align to standing up markets and supporting current markets in collaboration with the aligned HR Business Partner Lead (HRBPL) and act as a facilitator for the company's management team. They will need to apply broad experience in various Humana Resources (HR) areas of expertise. Work assignments will involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior HR Business Partner acts as a single point of contact for a broad range of business and HR partners across the Retail segment. Work will focus cyclically on the support of Medicaid RFA/RFI/RFP responses and the subsequent stand up or change of markets and work across partners in Medicaid, HR and other shared services to ensure the successful bid and stand up/operation of new and existing plans. In addition this work is closely aligned with the work of HRPBLs on this team and others to lead a strategy that ensures the successful growth and operation of our Medicaid line of business and facilitate superior member care delivery in all states. Responsibilities will include the identification, documentation, and implementation of best practices and support of the delivery of HR processes across Medicaid. This role will be accountable for identifying gaps, proposing and implementing changes necessary to cover risks and will act as a performance improvement driver and provoke positive changes in people management, lead change management projects and facilitate HR related internal and external communication. The successful candidate will influence our department’s strategy, make decisions on moderately complex to complex issues regarding technical approach for project com

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Risk Management is charged with protecting company assets. This group is responsible for minimizing risk – in legal, financial and operational areas – and its affects on the organization, as well as for enforcing security and safety measures. Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances. Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner appeals, complaints and grievances for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals, complaints and grievance. Responsible for day-to-day implementation of Aetna's appeals, complaints and grievances policies and procedures. Identifies trends and issues; reports on and recommends solutions. Accountable for meeting the financial, operational, and quality objectives of the unit. -Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns. -Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation req

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a Medicaid Proposal Writer, you will play a critical role in the quality of our RFP responses and the efficiency of the whole team. As the Proposal Writer, you will continuously strive to increase your knowledge of Aetna Medicaid, products offered, and industry best practices to develop thoughtful, strategic, compliant responses to RFPs/RFIs. This role is a work from home opportunity, which can be based anywhere in the United States. Job Responsibilities: Work on writing assignments varying in length and detail supporting strategic, functional, and operational topics across the entire proposal Collaborate with Capture and Proposal Managers, Proposal Directors, and Subject Matter Experts to outline and prepare final proposal responses Analyze proposal sections and content development to identify connections, ensure alignment, and support a cohesive overall narrative Interviews with subject matter experts (SMEs) to identify and collect pertinent information for compliant and compelling responses, upd