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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 Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience. Responsibilities Include: Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long-term scalability and sustainability. Leads implementation of new NCOD workflo

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: Registered Nurse Company: Oak Street Health Location: 89-14 Parsons Blvd, Jamaica, NY 11432 Role Description: The Center Nurse is a clinical care team member operating within a Value-Based Care model, which prioritizes patient health outcomes and long-term wellness. In this model, the Center Nurse supports the health of patients by utilizing standards, guidelines and pathways for care delivery to prevent complications before they occur. Our Center Nurses drive quality care through clinical assessments, chronic condition management, and collaborating with the care team to reduce avoidable hospitalizations. You will foster an engaging and welcoming environment through effective team communication and delegation, empowering everyone on the team to deliver the best care to our patients. Our Center Nurses report to the Practice Manager. Core Responsibilities: Support patient assessment and prioritization for both walk-in and telephonic triage to ensure patients receive the right level of care and avoid unnecessary hospital visits. Execute protocol-driven chronic condition management. Perform skilled nursing procedures including wound care and medication administration (including vaccines). Provide comprehensive patient and caregiver education regarding chronic conditions and

Become a part of our caring community Humana’s Quality and Cost Strategy Analytics Team is seeking a Research Scientist 2 (Remote). Healthcare is rapidly changing, and our members are living longer, often with more chronic conditions. The Quality and Cost Strategy Analytics team identifies opportunities and build solutions to improve clinical outcomes and lower costs for millions of Medicare Advantage beneficiaries leveraging data science & analytics, clinical expertise, strategic mindset, and rigorous study designs. In this multi-disciplinary team, you will have the opportunity to work closely with strategy partners and clinicians to shape Humana’s future enterprise clinical strategies and initiatives. The Research Scientist 2 will lead research, evaluation and development of opportunities that optimize healthcare delivery, lower medical cost while improve member health outcomes, through applying mathematical, statistical, epidemiologic and data science methods. The Research Scientist 2 will also partner with stakeholders across the enterprise to identify, prioritize and measure the impact of core and novel solutions to significant problems in healthcare and improve the health of especially underserved population, using high volumes of structured and unstructured data. Responsibilities As a Research Scientist 2, you will: Research, prototype and scale new ideas to improve population health and healthcare delivery Collaborate with analytic and business teams to set objectives, approaches, and work plans Collaborate with strategy to evaluate existing programs and identify and measure new solutions to impact healthcare Leverage a wide range of analytics methods ranging from descriptive to prescriptive to transform high volumes of complex data into analytics solut

The Personal Banker SAFE Act is an entry level position responsible for the assistance in the execution of sales, products or service activities in coordination with the customer service team. The overall objective of this role is to foster relations with customers to build loyalty and to help increase sales to individual consumer clients. Responsibilities: Work with business credit requests less than $250K, recognize/refer larger lending opportunities and cross sell treasury and related small business products Build referral business opportunities through Centers of Influence (COIs) and the Member Get Member (MGM) Program Assist in strategies to grow the small business client and implement appropriate sales plans to target Book of Business customers Deliver client services/outbound calls/inbound calls to acquire new relationships and deepen existing relationships through the cross-sell of relevant products and services while delivering remarkable client experience Provide Tellers and other branch staff with coaching and guidance on products and special programs, identifying client needs, and providing appropriate referrals Recognize transaction needs of clients, educate clients on all service and digital channels and leverage technology/ marketing tools available to uncover opportunities, and present product offers/financial solutions Understand and comply with Citibank policies, standards and procedures Appropriately assess risk when business decisions are made, demonstrating particular consideration for the firm's reputation and safeguarding Citigroup, its clients and assets, by driving compliance with applicable laws, rules and regulations, adhering to Policy, applying sound ethical judgment regarding personal behavior, conduct and business practices, and escalating, managing and reporting control issues with transparency. Qualifications:</u

The Personal Banker SAFE Act is an entry level position responsible for the assistance in the execution of sales, products or service activities in coordination with the customer service team. The overall objective of this role is to foster relations with customers to build loyalty and to help increase sales to individual consumer clients. Responsibilities: Work with business credit requests less than $250K, recognize/refer larger lending opportunities and cross sell treasury and related small business products Build referral business opportunities through Centers of Influence (COIs) and the Member Get Member (MGM) Program Assist in strategies to grow the small business client and implement appropriate sales plans to target Book of Business customers Deliver client services/outbound calls/inbound calls to acquire new relationships and deepen existing relationships through the cross-sell of relevant products and services while delivering remarkable client experience Provide Tellers and other branch staff with coaching and guidance on products and special programs, identifying client needs, and providing appropriate referrals Recognize transaction needs of clients, educate clients on all service and digital channels and leverage technology/ marketing tools available to uncover opportunities, and present product offers/financial solutions Understand and comply with Citibank policies, standards and procedures Appropriately assess risk when business decisions are made, demonstrating particular consideration for the firm's reputation and safeguarding Citigroup, its clients and assets, by driving compliance with applicable laws, rules and regulations, adhering to Policy, applying sound ethical judgment regarding personal behavior, conduct and business practices, and escalating, managing and reporting control issues with transparency. Qualifications:</u

Job Details: Job Description: Embark with us on a journey of growth and transformation as we create exceptionally engineered technology and bring AI everywhere. As a valued team member, your adaptability and attention to detail will contribute to our drive for results and relentless pursuit of quality, ensuring we meet our customers' needs with precision. Join us and build on our legacy of innovation and collaboration as we deliver world‑changing technology that improves the life of every person on the planet. Life at Intel: https://jobs.intel.com/en/life-at-intel This position is in the Intel Mask Operations within the Logic Technology Development team working in one of the most advanced semiconductor process technologies in the world. In this position the engineer will be an integral contributor to the ongoing production of photolithography masks for Intel's leading-edge silicon manufacturing solutions. In this position, you will work on-site, in a dynamic and collaborative environment solving complex and challenging technical problems on sophisticated manufacturing processes and equipment. As an IMO Module Development Engineer, the responsibilities may include but not limited to: Process equipment installation and development. Equipment maintenance, management of troubleshooting activities, regular monitoring of process performance, defect analysis and reduction. Drives improvements on quality, reliability, cost, yield, process stability/capability, productivity, and safety/ergonomics. Working with cross functional teams to solve technical process and defect issues. Plans and conducts experiments to fully characterize the process throughout the development cycle. Establishes control systems to optimize and sustain production performance. D

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 Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data. Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors. Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid

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: Registered Nurse Company: Oak Street Health Role Description: The Center Nurse is a clinical care team member operating within a Value-Based Care model, which prioritizes patient health outcomes and long-term wellness. In this model, the Center Nurse supports the health of patients by utilizing standards, guidelines and pathways for care delivery to prevent complications before they occur. Our Center Nurses drive quality care through clinical assessments, chronic condition management, and collaborating with the care team to reduce avoidable hospitalizations. You will foster an engaging and welcoming environment through effective team communication and delegation, empowering everyone on the team to deliver the best care to our patients. Our Center Nurses report to the Practice Manager. Core Responsibilities: Support patient assessment and prioritization for both walk-in and telephonic triage to ensure patients receive the right level of care and avoid unnecessary hospital visits. Execute protocol-driven chronic condition management. Perform skilled nursing procedures including wound care and medication administration (including vaccines). Provide comprehensive patient and caregiver education regarding chronic conditions and preventative care in person, over the

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. Registered Nurse Case Manager – Field in Suffolk, Brooklyn, Kings and Queens and surrounding counties, NY Position Summary: This position is a field‑based Registered Nurse (RN) role responsible for conducting member assessments for new NY Better Health enrollees, annual reassessments, semiannual reviews, and change‑in‑condition visits. The nurse will complete 2–3 home visits per day, with all documentation expected within 24 hours of each assessment. The role requires extensive travel (up to 75%) across assigned Suffolk and Surrounding Counties, NY and close collaboration with the Scheduler/CM Assistant who coordinates Work hours are Monday–Friday, 8:30 a.m.–5:00 p.m. EST. Key Responsibilities: Initial Assessments — Conduct member assessments for new NY Better Health applicants. Reassessments — Perform annual, semiannual, and change‑in‑condition assessments per regulatory and plan requirements. Clinical Documentation — Submit complete, accurate documentation within 24 hours of each visit. Care Coordination — Communicate findings to interdisciplinary teams to support care planning. Travel & Scheduling — Maintain punctuality and reliability for 2–3 daily home visits coordinated by the scheduling team. Independent Work — Operate effectively in a remote/telephonic environment while collaboratin

Become a part of our caring community The Senior Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Humana Pharmacy Benefits Management (PBM) Strategy Enablement team partners with PBM teams to improve processes that will help our members improve their lives through better health outcomes. This role, within the Process Improvement (PI) team of Strategy Enablement, will work closely with PBM leaders, as well as key partners in leading and delivering on initiatives and process capabilities that enable improved effectiveness, efficiency, and experiences (member, provider and associate). The Senior Process Improvement Professional: Researches best business practices within and outside the organization to establish benchmark data. Defines and leads business improvement projects aligned with business strategies and operational priorities. Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on member experience, increased productivity and efficiency and reduced cost. Determines how new information technologies can support re-engineering business processes. May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is perf

Become a part of our caring community The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Care Manager, Telephonic Behavioral Health 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Reports to the Regional CM Manager. Use your skills to make an impact Required Qualifications Must have an active, unrestricted SC Licensed Masters Social Worker (LMSW), Licensed Professional Counselor (LPC) OR an active, unrestricted compact Registered Nurse (RN) license . 2 or more years of experience working as a behavior

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 Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

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 Fraud, Waste, and Abuse (FWA) Analyst II identifies and develops potential healthcare fraud leads through data mining, claims analysis, and investigative research. As a key contributor to the SIU lead development process, this role evaluates provider, member, pharmacy, and ancillary healthcare billing patterns for signs of fraud, waste, abuse, and other anomalies. The Analyst II uses internal claims data, analytical tools, business rule results, and industry intelligence to assess potential FWA concerns and determine whether they warrant formal investigation. This role requires strong analytical skills, healthcare claims expertise, and the ability to translate complex data into actionable investigative leads and recommendations. Essential Responsibilities Lead Development & Fraud Detection Develop proactive and reactive leads to identify potential fraud, waste, and abuse. Generate FWA leads by mining claims databases, reporting tools, and investigative systems. Validate and refine leads generated by business rules to assess their credibility and investigative value. Examine spike analyses, utilization trends, payment anomalies, and outlier reports for unusual billing patterns. Evaluate provider, member, pharmacy, DME, transportation, and facility billing for indicators of fraud or abuse. Moni

The Personal Banker SAFE Act is an entry level position responsible for the assistance in the execution of sales, products or service activities in coordination with the customer service team. The overall objective of this role is to foster relations with customers to build loyalty and to help increase sales to individual consumer clients. Responsibilities: Work with business credit requests less than $250K, recognize/refer larger lending opportunities and cross sell treasury and related small business products Build referral business opportunities through Centers of Influence (COIs) and the Member Get Member (MGM) Program Assist in strategies to grow the small business client and implement appropriate sales plans to target Book of Business customers Deliver client services/outbound calls/inbound calls to acquire new relationships and deepen existing relationships through the cross-sell of relevant products and services while delivering remarkable client experience Provide Tellers and other branch staff with coaching and guidance on products and special programs, identifying client needs, and providing appropriate referrals Recognize transaction needs of clients, educate clients on all service and digital channels and leverage technology/ marketing tools available to uncover opportunities, and present product offers/financial solutions Understand and comply with Citibank policies, standards and procedures Appropriately assess risk when business decisions are made, demonstrating particular consideration for the firm's reputation and safeguarding Citigroup, its clients and assets, by driving compliance with applicable laws, rules and regulations, adhering to Policy, applying sound ethical judgment regarding personal behavior, conduct and business practices, and escalating, managing and reporting control issues with transparency. Qualifications:</u

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