Clinical Sales Specialist Jobs

Become a part of our caring community Services represent one of the organization’s most consequential sources of capability, capacity, transformation and external spend. The Associate Vice President, Services Procurement will lead the enterprise strategy for contingent workforce, outsourcing and offshoring, consulting and clinical services, converting third-party services into measurable business outcomes, workforce agility, operating leverage and sustainable value. The AVP will serve as the senior Procurement partner to leaders across the Insurance segment and Corporate Services, helping shape operating-model, workforce and transformation decisions before sourcing begins or a supplier solution is selected. The leader will bring deep expertise in global business services, business process outsourcing, workforce solutions and complex professional services. The mandate is to strengthen business-case quality, establish clear make, buy, build, automate and partner choices, create fit-for-purpose commercial models, manage transitions and hold providers accountable for committed outcomes. Success will be measured by whether business leaders make better services and workforce decisions, transformations deliver their promised value, and suppliers improve performance and innovation. Key Responsibilities Serve as the Strategic Services Partner to Business Leaders Serve as the senior Procurement relationship leader and trusted commercial advisor to Insurance segment and Corporate Services leadership. Develop a deep understanding of business strategy, operating plans, transformation roadmaps, workforce needs and financial commitments, and translate them into integrated services, workforce and supplier strategies. Engage upstream of supplier selection to frame the problem, test demand and assess make, buy, build, automate, offshore, outsource

Become a part of our caring community Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative 2, where you will play a critical role in addressing client concerns and denials. You will perform thorough reviews of clinical documentation to assess whether grievances, appeals, or additional requests are justified. Then, you will provide final determinations utilizing your expertise and collaboration with clinical and other Humana teams. Your contributions will directly support Humana's commitment to delivering high-quality service and making a positive difference in the lives of those we serve. Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Key Responsibilities: Assign cases to team members for submission to an independent entity for 2nd level review. Monitor and record the number of cases assigned to the team, as well as the distribution of cases among individual associates. Operate within established guidelines to maintain work expectations and quality standards, while exercising discretion in prioritizing tasks and managing timelines with minimal supervision. Demonstrate flexibility and resilience in adapting to evolving processes and a fast-paced work environment. Use your skills to make an impact Required Qualifications Minimum of 1 year of customer service experience Minimum of 1 year of data entry experience Experience in a production-driven environment Must have strong experience using multiple Microsoft systems simultaneously (Teams, SharePoint, Excel, etc.) Ability to manage large volume on inventory daily Preferred Qualifications Previous inbound call center or related customer service experi

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. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond the bedside? Join our team and use your clinical expertise to ensure members receive the right care at the right time. What You’ll Do Review clinical cases and make coverage determinations using evidence-based guidelines Collaborate with providers and care teams to coordinate appropriate treatment Apply clinical judgment to support utilization and benefit management decisions Identify opportunities to improve care quality and member outcomes Serve as a clinical resource across internal and external stakeholders What You Bring - REQUIRED Active, unrestricted RN license in the state of residence. 3&#43; years of RN experience, including 1&#43; year in Med/Surg Strong clinical assessment and decision-making skills Experience with Microsoft Office (Outlook, Teams, Excel) Ability to work Monday–Friday, 9:00 AM–6:00 PM in your time zone. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours Associate Degree in Nursing Nice to Have Utilization Management or Prior Authorization experience Managed care background</l

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 - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication

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 - Supports comprehensive coordination of Medicaid and/or Medicare pharmacy services including intake and processing of pharmacy authorization requests. - Promotes and supports quality effectiveness of healthcare and Pharmacy Services. - Evaluates, authorizes approval, and communicates decisions for pharmacy requests according to clinical guidelines. - Evaluates and authorizes approval of pharmacy requests received by telephone, facsimile, and/or other means using client clinical criteria. - Determines appropriateness for medications. Communicates decision to physicians, physician’s office staff, medical management staff, members, and/or pharmacists. - Will perform clinical research to support request. - Performs non-medical research including eligibility verification, COB, and benefits verification. - Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. - Process requests in compliance with various laws and CMS regulations and company policies and procedures. - May communicate with Aetna Case Managers, Health Plan Staff, External Pharmacies and Health Care Providers. - Promotes communication, both internally and externally, to enhance effectiveness of medication therapy management services. - Sedentary work involving significant periods of sitting, tal

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 This is a remote work from home role anywhere in the US but must be able to work EST hours. Working hours will be Monday-Friday 8am-4:30pm EST. No weekends, holidays, or travel will be required. The Clinical Case manager is a licensed Clinical Social Worker position. This role partners with a registered nurse case manager to utilize a collaborative process of assessment, planning, and advocacy to meet a member’s benefit plan and/or health needs. Responsibilities include researching available options and resources for members with financial, transportation, safety and housing needs. Population spans the entire lifecycle. All member contact is done telephonically or via electronic exchange. This position works to empower members to make positive lifestyle and medical choices and works as a team with other clinical staff to assist members with community resources for medical, financial and behavioral health. Required Qualifications Must live in North Carolina Master's Degree in Social Work

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. Title: Associate Practice Manager Company: Oak Street Health Role Description: The purpose of an Associate Practice Manager at Oak Street Health is to lead and manage operations at a single primary care clinic location in accordance with company values and standards. Associate Practice Managers supervise clinical and non-clinical team members, support operational initiatives, drive their team towards achieving patient satisfaction and clinical outcomes measured via a variety of metrics, and generally ensure the clinic is running smoothly and in a timely manner on a daily basis. Core Responsibilities: Staff Management and Development Hire, train, supervise, coach, mentor and manage a multi-disciplinary team of 15&#43; Ensure the center is a Great Place to Work and our teams are engaged and thriving; build a culture of engagement and demonstrate the Values and Service Behaviors at all times Clinic Operations Ensure clinic operations are running smoothly and safely on a daily basis, including ensuring there is adequate staffing each day, arranging coverage for any call-offs or scheduled PTO and ensuring that all Standard Operating Procedures are followed Ensure that we are providing an Unmatched Patient Experience and provide service recovery as needed Drive result

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. This is a Full Time Float position in the Chattanooga market. A Brief Overview As the largest retail health care provider in the nation and a Fortune Top 10 industry leader, MinuteClinic offers a unique opportunity to deliver affordable, accessible, and comprehensive high‑quality care to patients, families, and communities. Our providers are empowered to practice holistically with strong clinical support, collaborative resources, and a unified “one store, one team” approach. This is a clinic-based role focused on delivering the highest-level quality in-person patient care. Virtual care visits may be conducted from the clinic during periods of lower onsite patient volume and when doing so does not delay or interfere with in‑person care. MinuteClinic is proud to hold the American Nurses Credentialing Center (ANCC) Pathway to Excellence® designation, recognizing our commitment to a healthy work environment through Transformational Leadership, Quality, Safety, Shared Governance, Well-being, and Professional Development. What Our Providers Enjoy Autonomy to manage your practice with dedicated collaborative and organizational support Flexible scheduling and strong work–life balance Exceptional tools, training, and clinical resources Evidence‑based guidelines and access to leading assessment and treatment planning tools</l

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 We are seeking a skilled and analytical Senior Product Analytics Associate to lead the development and execution of a data-driven product roadmap. The ideal candidate will have a deep understanding of product analytics, strong problem-solving skills, and experience working with cross-functional teams to support strategic initiatives. As a Senior Product Analytics Associate, you will work closely with cross-functional teams including engineering, product, and clinical operations. Roles and Responsibilities: Define, track, and report on product metrics including performance and profitability Build and maintain robust data transformation models using dbt (or similar frameworks like Dataform or SQL-based ETL tools) to ensure analytics-ready datasets Design and interpret A/B tests; when A/B testing is not feasible, apply causal inference methods (e.g., Diff-in-Diff, Propensity Score Matching) to determine product efficacy. Develop ROI projections for analytics projects to prioritize deliverables by business impact Tell compelling stories through data, articulating technical information to a non-technical audience Build and maintain Power BI dashboards to

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 - Processes prior authorization requests received by phone, fax, or electronically and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - Proactively completes prior authorization approvals and denials that are due to expire and maintains complete, timely, and accurate documentation. - Reviews potential prior authorization denial language to ensure NCQA requirements are met. - Follows prior authorization workflow, policies, and procedures during the course of the workday. - Answers a potentially high volume of prior authorization inquiry calls from provider's offices, pharmacies, and internal partners and uses various computer resources to communicate prior authorization status or decisions. - Maintains a balance of productivity, quality and timeliness of work. - Participates in training and continuing education as required. - Participates in team/departmental meetings as required. - Excellent attendance is a must. - Successful pharmacy technicians will be proficient in drug name and diagnosis pronunciation, recognizing medical terminology, and navigating multiple computer resources to document conversations and prior authorization decisions. - Successful pharmacy technicians will possess good written and verbal communication

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. Title: Medical Scribe Monday - Friday, 8a-5p, full time Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. Because

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. Company: Oak Street Health Title: Medical Scribe (Clinical Informatics Specialist) Location: 103 Country Club Dr, Fayetteville, NC 28301 Role Description: At Oak Street Health, Clinical Informatics Specialists (CIS), or Medical Scribes, serve as vital clinical documentation assistants, supporting our primary care providers. Each Scribe is paired with a single provider, joining them in the exam room, during team huddles, and conducting post-visit summaries to ensure accurate, specific, and timely documentation. Our Scribes receive extensive training to become experts in our value-based care model, ICD-10 and CPT coding, electronic medical records, and population health. Their contributions allow our interdisciplinary team to proactively identify and help close care gaps, provide preventative measures for chronic conditions, and provide great patient experiences. This role is designed for individuals seeking significant clinical exposure, particularly those on a pre-med or healthcare administration track. Because providers and patients rely heavily on this partnership, successful candidates should expect a 1 - 2 year commitment. This oppo

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. This is for a full time every other weekend float position in the Southern Indiana market. A Brief Overview As the largest retail health care provider in the nation and a Fortune Top 10 industry leader, MinuteClinic offers a unique opportunity to deliver affordable, accessible, and comprehensive high‑quality care to patients, families, and communities. Our providers are empowered to practice holistically with strong clinical support, collaborative resources, and a unified “one store, one team” approach. This is a clinic-based role focused on delivering the highest-level quality in-person patient care. Virtual care visits may be conducted from the clinic during periods of lower onsite patient volume and when doing so does not delay or interfere with in‑person care. MinuteClinic is proud to hold the American Nurses Credentialing Center (ANCC) Pathway to Excellence® designation, recognizing our commitment to a healthy work environment through Transformational Leadership, Quality, Safety, Shared Governance, Well-being, and Professional Development. What Our Providers Enjoy Autonomy to manage your practice with dedicated collaborative and organizational support Flexible scheduling and strong work–life balance Exceptional tools, training, and clinical resources Evidence‑based guidelines and access to leading assessment a

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. Title: Medical Scribe Company: Oak Street Health Role Description: The purpose of a Clinical Informatics Specialist (CIS or Medical Scribe) at Oak Street Health is to support our primary care providers with clinical documentation so that they can focus on providing exceptional care to our patients. Scribes assist providers throughout the patient care journey - huddling each morning to plan for the day's visits, joining them in the exam room to observe and document, and touching base after the visit to assist with next steps. Beyond the typical Scribe role, these important care team members serve as clinical documentation assistants to their paired provider. Internally, we call them CISs (Clinic Informatics Specialists) in recognition of their important role in supporting accurate, specific, and timely clinical documentation. In addition to observing and documenting all patient encounters in real time, our Scribes become experts in our value-based care model and the documentation and care of chronic conditions, including ICD-10 and CPT coding. Scribes use this expertise to help providers identify and help close care gaps. Scribes receive extensive on-the-job training in clinical workflows, value-based medicine, preventative care for chronic conditions, accurate and specific documentation, population health data streams, and team based care. <

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 As the largest retail health care provider in the nation and a Fortune Top 10 industry leader, MinuteClinic offers a unique opportunity to deliver affordable, accessible, and comprehensive high‑quality care to patients, families, and communities. Our providers are empowered to practice holistically with strong clinical support, collaborative resources, and a unified “one store, one team” approach. This is a clinic-based role focused on delivering the highest-level quality in-person patient care. Virtual care visits may be conducted from the clinic during periods of lower onsite patient volume and when doing so does not delay or interfere with in‑person care. MinuteClinic is proud to hold the American Nurses Credentialing Center (ANCC) Pathway to Excellence® designation, recognizing our commitment to a healthy work environment through Transformational Leadership, Quality, Safety, Shared Governance, Well-being, and Professional Development. What Our Providers Enjoy Autonomy to manage your practice with dedicated collaborative and organizational support Flexible scheduling and strong work–life balance Exceptional tools, training, and clinical resources Evidence‑based guidelines and access to leading assessment and treatment planning tools Opportunity to deliver both in‑person and virtual care, driven by in‑cl