Care Management Specialist Jobs

Job Description Role Summary The Managed Services Analyst role provides excellent customer service to both internal and external customers to assist with products or services provided by GHX. This role provides administrative process support for routine tasks. This individual will have a passion for customer service and performance excellence. In addition, this role will demonstrate excellent verbal and written communication, analytical, problem-solving, project management and coordination skills, as well as the ability to develop and maintain strong business relationships both internally and externally. This position requires effective time management skills, thorough attention to detail, ability to cross-train peers, and a high level of integrity. Required Skills Strong English language and comprehension skills with clear and effective verbal and written communication Ability to self-learn based on reviewing passed resolutions and feedback from team Ability to identify learning opportunities and self-educate where resources and opportunities are Ability review process and recognize inefficiencies and highlight it to leaders and partner in execution as required Ability to recognize problems, gather information, and escalate to leadership when Must be able to follow documented process and detail Strong accountability and integrity due to sensitive nature of information Strong customer support Grow and adapt to changing guidelines or Prioritize, multitask, and carry out projects correctly in a timely Proactively work with limited direction and/or Demonstrate the ability to exercise independent judgment and Internet savvy and computer literacy with proficiency in all Microsoft Office applications Preferably exposed to Salesforce environment for case handling. Roles & Responsibilities Provide support for external customers via email for assistance with questions, education and resolution of problems. Handle daily case work while meeting predetermined KPI and QA Acc

Job Description Role Summary The Managed Services Analyst role provides excellent customer service to both internal and external customers to assist with products or services provided by GHX. This role provides administrative process support for routine tasks. This individual will have a passion for customer service and performance excellence. In addition, this role will demonstrate excellent verbal and written communication, analytical, problem-solving, project management and coordination skills, as well as the ability to develop and maintain strong business relationships both internally and externally. This position requires effective time management skills, thorough attention to detail, ability to cross-train peers, and a high level of integrity. Required Skills Strong English language and comprehension skills with clear and effective verbal and written communication Ability to self-learn based on reviewing passed resolutions and feedback from team Ability to identify learning opportunities and self-educate where resources and opportunities are Ability review process and recognize inefficiencies and highlight it to leaders and partner in execution as required Ability to recognize problems, gather information, and escalate to leadership when Must be able to follow documented process and detail Strong accountability and integrity due to sensitive nature of information Strong customer support Grow and adapt to changing guidelines or Prioritize, multitask, and carry out projects correctly in a timely Proactively work with limited direction and/or Demonstrate the ability to exercise independent judgment and Internet savvy and computer literacy with proficiency in all Microsoft Office applications Preferably exposed to Salesforce environment for case handling. Roles & Responsibilities Provide support for external customers via email for assistance with questions, education and resolution of problems. Handle daily case work while meeting predetermined KPI and QA Acc

Role: Senior Cloud Engineer Location: Hyderabad, India (Hybrid) Department: Product Development About GHX: GHX (Global Healthcare Exchange) is a leading healthcare technology company on a mission to simplify the business of healthcare and improve patient outcomes. Founded in 2000, GHX has built the GHX Global Network — the world’s largest cloud-based supply chain community connecting healthcare providers, suppliers, distributors, and partners to automate key processes, reduce costs, and increase operational efficiency. Its solutions span electronic trading, procurement automation, inventory and contract management, business intelligence, and data synchronization, helping healthcare organizations improve productivity and focus more on patient care. Over the years, GHX has enabled significant cost savings for the industry and continues to innovate with intelligent automation and AI-driven capabilities. Website: https://www.ghx.com/ LinkedIn: https://www.linkedin.com/company/ghx/ About Role: The Senior Cloud Engineer leads the design, implementation, and operations of the organization’s cloud infrastructure. This role is responsible for complex projects, high-level architectural planning, and making strategic technology decisions that support scalability, performance, security, and cost optimization. Acting as a technical leader, the Senior Cloud Engineer provides mentorship to junior and mid-level engineers while driving innovation, resiliency, and compliance in cloud environments. Key Responsibilities: Design and Implementation Lead the design and implementation of cloud-native architectures and hybrid cloud solutions. Oversee cloud engineering projects, ensuring solutions are secure, resilient, and cost-effective. Contribute to high-level architectural planning and strategic decision-making around technology adoption. Review and approve design proposals, Infrastructure as Code (IaC) tem

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. Job Description Serves as a Technical Digital Product Implementation Manager for Aetna Health Customizations supporting plan sponsors and Book of Business products. Candidate will lead and oversee the deployment and integration of advanced digital technologies, including SSO, API, and content management systems. Role requires autonomously driving successful implementation while managing multiple deliveries and collaborating with several business partners. This position requires strong communication, project management, and technical skills combined with healthcare industry knowledge to implement digital enhancements that improve the member experience, create operational efficiency, and ensure compliance with industry regulations. Key Responsibilities: Independently lead the end-to-end implementation of digital technology solutions, including SSO and API integrations, in conjunction with internal and external partners. Own all portions of project delivery, including; requirement gathering, project documentation, facilitation and collaboration efforts with all impacted parties, testing, release, and support. Collaborate with business stakeholders to understand their needs, define project scope, and ensure alignment with organizational goals. Communicate project progress, risks, and/or blockers, to progress project and show transparency in approac

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 The Workforce Optimization Manager plays a critical role in shaping and executing workforce strategies. This position leads the end-to-end lifecycle of workforce optimization initiatives. Acting as a trusted advisor, this role partners with leaders across all levels to align workforce plans with business objectives, proactively anticipate organizational needs, and mitigate risk through compliance with employment laws and sound governance. This role has no direct reports but manages an important process within the workforce optimization space. Key Responsibilities Drive end‑to‑end project management for high‑impact workforce optimization initiatives, operating effectively in grey areas where requirements, risks, and stakeholder inputs may be evolving. Partner closely with Government Affairs, Legal, Talent Acquisition, Communications, and HR to scope work, align resources, manage timelines, mitigate risk while managing the project plan. Serve as an enterprise‑wide strategic advisor to leaders at all levels, providing consultative guidance in complex, ambiguous, and high‑impact scenarios where solutions are not clearly defined and require strategic judgment, influence, and risk assessment to inform workforce strategy and future‑state design. Influence talent decisions by evaluating current capabilities against future organizational needs, iden

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 CVS Health is one of the leading specialty pharmacies in the country, dispensing or managing more than $70B of specialty medications annually. Continued leadership in this space is a key fundamental priority for the organization. The Specialty Trade organization is a critical partner responsible for gaining access to drugs through either broad or limited distribution arrangements, negotiating product acquisition economics and selling in valuable services that differentiate us as a leading specialty pharmacy. Do you want to make a large impact in your next role? Join CVS Health as a Lead Director Specialty Trade Relations, where you will be involved in the development and execution of key strategies and initiatives with specialty pharmaceutical manufacturers. Strategies will include procurement of products, distribution strategies, acquisition economics, specialty services such as data and reporting services, adherence programs and other performance services. In this high impact role, you will have direct account responsibilities for established blood product manufacturers (hemophilia & IVIG), manage pharma relationships at a leadership level, be accountable for the cost of goods of pharmaceutical manufacturer products, and improvement in the reduction of these costs, while also identifying and executing new opportunities for current and new manufacturers. Here, you

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 CVS Health is looking for a Functional & Technical Expert for the Varicent Sales Performance Management (SPM) platform to join our Human Resources Technology team. We’re seeking an experienced and motivated individual who is ready to take on the challenge of supporting Compensation business operations by providing optimal and scalable technology solutions. This person will be an integral part of a team responsible for Compensation solutions meeting the needs of CVS Health’s Total Rewards, and Human Resources business partners and stakeholders. The ideal candidate will possess a combination of functional and technical expertise, as well as a demonstrated ability to work collaboratively with both technical and non-technical partners. You will provide integral support to the Compensation Team for their sales incentive technology needs collaborating with HR Shared Services across all business segments. You will establish cross-functional relationships throughout HR Technology and Human Resources to ensure solutions and initiatives are effectively designed and implemented. Primary Responsibilities : Collaborate with business and technical partners to support the Compensation functional area for Sales Incentives, including the established list of global priorities and roadmaps. Work closely with business leaders and stakeholders to develop v

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 The Project Manager, Events coordinates the end-to-end execution of external events that showcase Aetna’s industry expertise, highlight differentiated solutions, and strengthen partnerships with external partners to drive sales growth and retention. They manage multiple concurrent projects, ensuring alignment with business objectives while increasing awareness of available tools and resources across both internal and external stakeholders. The role partners closely with sales leaders, strategic partnerships, subject matter experts and marketing to deliver high-impact experiences. Required Qualifications 5-7 years exceptional organizational and prioritization skills, with the ability to manage multiple projects simultaneously Strong verbal and written communication skills, with the ability to engage stakeholders at all levels Proven ability to collaborate across cross-functional teams Demonstrated project management expertise with a track record of delivering on timelines and milestones Ability to proactively identify challenges and drive solutions to maintain momentum Ability to operate effectively in a fast-paced, matrixed environment Preferred Qualifications PMP certification Education Bachelor's degree or equivalent experience

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. Summary The Senior Manager, Pharmacy Operations provides strategic leadership and site-level alignment for back-end mail-order pharmacy operations. This role is responsible for driving operational excellence, financial performance, compliance, talent development, and cross-functional collaboration while supporting the successful execution of enterprise initiatives and business objectives. A Brief Overview Manages day-to-day operations of pharmacy support staff by providing strategic leadership and oversight for pharmacy support operations. Develops and implements operational strategies, establishes performance metrics, and drives process improvements to contribute to strategic decision-making regarding pharmacy support initiatives and goals. Collaborates with stakeholders, such as pharmacists and healthcare providers, to ensure effective communication, efficient workflow coordination, and adherence to quality and safety standards. Fosters a supportive and productive work environment and facilitates professional development opportunities for the team. What you will do Provide strategic leadership and oversight of all site operations to ensu

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

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 Performs complex medical economic projects (e.g. contract rate modeling) Accountabilities include identification and completion of key deliverables to ensure all business objectives are met. Responsible for the development and implementation of key medical economics business efforts e.g.medical cost initiatives, policies/programs, budget and analytical models. Partners and consults with Network Management to provide medical cost analysis to assess effectiveness of contracted rates, creating and implementing plans to effectively manage medical costs based on analysis or trends. Develops market specific provider reimbursement schedules Oversees the production of both standard and ad-hoc reports used for risk assessment analysis, budgeting, and hospital chargemaster analysis and forecasting. Coordinates rate approvals and develops pricing for most complex contractual arrangements. Develops and communicates tactical and strategic plans to satisfy information needs across products, segments and markets to a broad audience Required Qualifications 3+ years demonstrated leadership and/or project management experience 3+ years of healthcare and/or analysis experience. Preferred Qualifications • Knowledge of managed care and how provider reimbursement policies relate to the control of me

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 The Executive Director - Business Information Security Officer (BISO) will serve as a senior leader and trusted security advisor supporting all CVS Health lines of business, with accountability for leading the BISO team and driving mission, vision, and governance model. This individual will provide senior‑level leadership, strategic and tactical guidance for a world‑class enterprise cybersecurity program. As a business enabler, the BISO is an effective communicator with the technical aptitude to embed security strategy and risk‑based decision‑making into all aspects of the business. The BISO understands security risks, threats, vulnerabilities, control frameworks, and security technologies and translates their impact in business terms. The BISO must be capable of working closely with senior IT business leaders, executive leadership, and business subject matter experts (SMEs). This role requires demonstrated leadership, exceptional organizational skills, strong business and financial acumen, and the ability to influence and drive change at scale across the organization. <

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 The Lead Director, Corporate Communications will support the business objectives of the Chief Pharmacy Officer and Head of Specialty Operations by helping to develop and lead the execution of a communications strategy that advances key business and enterprise priorities. This role will drive communications in support of CVS Specialty’s business objectives while also leading executive communications, thought leadership opportunities, and content development that strengthen the voice and visibility of the Chief Pharmacy Officer across internal and external channels. The Lead Director will help shape communications that advocate for the evolving role of the pharmacist and advance the practice of pharmacy in alignment with the education and training of these professionals. In addition, this role will support communications strategy and execution for CVS Specialty, helping translate business priorities into clear, compelling messaging that underscores key differentiators of the business, including its focus on simplifying the patient experience, optimizing clinical outcomes through expert care and personalized support, and improving experiences through market-leading innovation and technology. This role requires a highly skilled communications leader who can counsel senior executives, translate complex healthcare and business issues into clear and compelling messaging, and o

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: As a Senior Manager of Medicaid Compliance, you are responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization operating in a moderately complex regulatory environment. This role will allow you to serve as the designated Compliance Officer for Aetna’s Michigan (MI) Medicaid health plan. You will oversee the activities of other compliance team members assigned to the MI market. You will be responsible for developing and maintaining systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the assigned Medicaid health plan. Responsibilities include, but are not limited to: Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to state Medicaid agencies on or before required due dates; independently prepares and oversees the submission of complex regulatory reports and deliverables as needed on behalf of the Medicaid compliance team Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction wit

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. A Brief Overview Carries out and facilitates Scrum events, removes impediments, promotes collaboration, supports Product Owners, and drives continuous improvement across Agile teams. Ensures the effective implementation of the Scrum framework by creating an environment that enables team success, fosters continuous learning, and delivers business value. Coaches and mentors Scrum Masters and Agile teams while championing Agile principles, servant leadership, and organizational agility. What You Will Do Agile Leadership & Team Coaching Coaches Scrum Masters, Product Owners, and Agile teams on Agile principles, Scrum values, and best practices for project and product delivery. Guides teams in self-organization, cross-functionality, accountability, and continuous improvement. Promotes a growth mindset and fosters a culture of adaptability, transparency, collaboration, and experimentation. Helps establish and implement a common language and framework for Agile team collaboration. Scrum Facilitation & Delivery Excellence Facilitates and oversees Scrum ceremonies, including daily stand-ups, sprint planning, sprint reviews, retrospectives, and backlog refinement sessions. Removes impediments and proactively addresses risks and obstacles that impact team productiv