Provider Contracting Professional Jobs

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 (RN) Make a meaningful impact on patient care from wherever you are. We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you will use your clinical expertise to review healthcare services, support appropriate care decisions, collaborate with providers, and help members navigate their healthcare journey. What You'll Do Review clinical information and apply evidence-based criteria to make coverage recommendations. Collaborate with healthcare providers and internal teams to support quality patient outcomes. Identify opportunities for care coordination and member support programs. Promote effective healthcare utilization and contribute to high-quality service delivery. Manage multiple systems and priorities in a fast-paced, team-oriented environment. Required Qualifications Active, unrestricted RN license in your state of residence. Minimum 2 years of RN experience in an adult acute care or critical care setting . Associate's Degree in Nursing. Strong communication, computer, and multitasking skills. Ability to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation. Preferred Qualificatio

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 Prescription Records team serves as the sole managing interface for CVS Retails’ legal, subpoena, regulatory, attorney, patient and third-party record demands for patient and prescriber prescription records. This position will handle incoming customer inquiries by phone, fax and email in a contact center environment. You will have high-volume data entry expectations of these requests while ensuring the accuracy of details provided, along with being in charge of responsibly handling Protected Health Information. We have the responsibility of complying with regulatory demands and subpoena demands in accordance with state and federal HIPAA/Privacy requirements. Role Overview Shift: Monday-Friday 8:30-5:00 PM EST Hybrid: Must be able to work 2 days a week in the Cumberland, RI office. (Thursday are mandatory) Training Schedule: First 2 weeks training fully onsite in Cumberland following the regular schedule of 8:30-5:00 PM EST What you will do Work in a high volume, production oriented, time sensitive Call Center environment. Assist customers on the phone to provide Prescription Records and status updates on their requests. Process prescription records in a data entry system in response to fax, mail, and email requests from Regulatory Agencies, Courts (S

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 Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp

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 Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp

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 It’s an exciting time for our Medical Economics team at CVS Health. As a growing team in a Fortune 5 company, we can provide amazing benefits to our employees along with continuous career development. This includes flexible work location, a great work-life balance, and a competitive salary. You will also be able to flex your analytics and consultative skills to positively impact our patients’ health. As a Medical Economics Sr Analyst, you will provide consultative support and medical cost-based analysis of markets and network initiatives. You will be responsible for consulting with network and clinical management on opportunities to improve our company’s discount position and strategic cost and utilization initiatives and is essential to managing conflicting priorities and multiple projects. 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. You will also: • Analyze and research utilization and unit cost medical costs drivers • Turn data into usable information by telling the story through data visualization • Support the development of scoreable action items by identifying outlier cost issues • Perform drill-down analysis to identify medica

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 Assistant Compensation : Based on regional bands Role Description The purpose of a Medical Assistant at Oak Street Health is to gather all necessary medical information regarding our patients to ensure providers have the most accurate information available when making healthcare decisions. Medical Assistants (MA) report to the Practice Manager or Center Operations Specialist. They are a vital element of our model and important members of our Care Teams. Being an MA at Oak Street Health requires high levels of flexibility, energy, attention to detail, and problem solving skills. You will be expected to build relationships with Oak Street Health members. Medical Assistants will collaborate closely with their teammates to ensure an unmatched patient experience while driving clinical results. As an MA you will accomplish this by assisting in the assessment of patients’ health conditions, through screenings and routine diagnostic testing performed during appointments. Check out this <a target="_blank" href="https://drive.google.com/file/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 ** Candidates MUST live in the state of CA, and be a licensed pharmacy technician with the CA Board of Pharmacy (BoP). ** The Pharmacy Technician – Clinical Support Services position is responsible for utilizing their clinical knowledge and excellent customer service skills to provide our patients with the smooth service and delivery of medication and supplies to their homes. You will make a difference by bringing your personal touch and clinical experiences that will support our patient’s one on one care. Coram CVS/specialty infusion is a national leader in the home infusion field. As part of the team, you will have an important, uniquely rewarding role putting your Pharmacy Technician skills and experience to work in a closed-door practice setting. Responsibilities • Partner closely with pharmacists to coordinate and process new patient referrals, prescription renewals, and ongoing refill management. • Serve as a primary point of contact for patients, <spa

You’ve invested a lot of time and energy in your education. Now you want the chance to make your mark. We offer challenging opportunities for you to learn and grow professionally. In our programs, you’ll be immersed in a culture of continuous improvement, with the goal of changing health care for the better. Position Summary As a Pharmacy Intern, you have a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to progression and development through our ExperienceRx™ program, you will also be accountable for assisting the Pharmacy team in providing an excellent experience for your patients. This includes the following under the supervision of a Preceptor where legal by state law: Participates in all aspects of the prescription filling process Providing Patient Counseling Collaboration with all Healthcare Professionals to provide coordinated patient care Offering Health Screenings and Immunizations when appropriate Customer Service Patient Safety Assisting Pharmacy Patients and Front Store customers with questions Pharmacy Professional Practice Regulatory Requirements Inventory Management A key component of the Pharmacy Intern’s role is keeping your customers and patients healthy through adoption and participation of patient care programs. Additionally, you will: Display empathy and compassion for your patients, customers, caregivers and colleagues on your team Motivate, and inspire your Pharmacy Team by providing, supporting and recognizing excellent patient care Identify critical business opportunities and contribute to the development of meanin

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 Assistant Company: Oak Street Health Role Description: The purpose of a Medical Assistant at Oak Street Health is to gather all necessary medical information regarding our patients to ensure providers have the most accurate information available when making healthcare decisions. Medical Assistants (MA) report to the Practice Manager or Center Operations Specialist. They are a vital element of our model and important members of our Care Teams. Being an MA at Oak Street Health requires high levels of flexibility, energy, attention to detail, and problem solving skills. You will be expected to build relationships with Oak Street Health members. Medical Assistants will collaborate closely with their teammates to ensure an unmatched patient experience while driving clinical results. As an MA you will accomplish this by assisting in the assessment of patients’ health conditions, through screenings and routine diagnostic testing performed during appointments. Responsibilities: Ensure an efficient patient flow; room patients in a timely manner, complete vital signs, complete required screenings and complete medication reviews Inventory supplies and stock exam rooms Respond to patient requests for telephonic support (Lab results, faxing records to specialists, etc.) In accorda

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, Senior Decision Scientist serves as a strategic analytics and ideation leader supporting Payment Integrity Affordability initiatives with a primary focus on Fraud, Waste & Error (FWE) and Special Investigations Unit (SIU) programs. This role provides leadership and guidance to a team of Decision Scientists while driving the development, evaluation, and implementation of innovative opportunities that improve affordability outcomes and strengthen Payment Integrity capabilities. The Lead Decision Scientist is responsible for establishing analytical frameworks, managing ideation pipelines, defining success metrics, and identifying cross-functional opportunities that create enterprise value across Payment Integrity programs. Required Qualifications 7&#43; years of experience in healthcare analytics, Payment Integrity, Fraud, Waste & Error (FWE), Special Investigations, or related healthcare operations. 5&#43; years of experience leading analytical projects or providing technical leadership within a healthcare environment. Demonstrated experience working with healthcare claims platforms including ACAS, QNXT, HRP, or comparable systems. Experience using SAS, SQL, Python, R, or other analytical and statistical programming languages. Experience performing advanced data analysis, opportunity identification, trend analy

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 Internal Audit Department provides high quality services to our internal business partners that consistently meet and exceed their expectations. We collaborate proactively with our business partners to focus on the most important risks/challenges facing the organization, to deliver results that make the most significant contributions, and to provide meaningful insights and solutions. We continuously look for ways to improve our audit processes and leverage technology to provide value in creative ways. Reporting to the Senior Manager of the Financial Controls Assurance Team, the Analyst of the Team will perform execution of the company’s Sarbanes-Oxley (SOX) regulatory requirements, and promote collaboration with our business partners, external auditors, and management. The position executes SOX testing and supports the annual planning process. This role will be responsible for continually evaluating and recommending operational and process improvements to our financial compliance processes, and the efficiency and effectiveness of the company’s key control structure. Also, the role will have opportunities to collaborate on cross-functional project teams providing value in support of CVS Health achieving its transformational goals. This role is inclusive of testing and design of IT automated controls. Required Qualifications 0-2 ye

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 Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease manag

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. The Store Manager In Training (SMIT) job is a development focused role that is crafted to prepare you for a CVS Store Manager position. The SMIT program is designed to enhance your career as a future store leader. We support your development towards the store manager role by participating in a self-paced, collaborative training over the span of 16 weeks. We provide both virtual and hands on learning experiences to develop you as a leader. Our team of people, that support your growth toward your leadership career include: your District Leader, Human Resources Business Partner, Training Store Manager, and your Store Manager coach. Some of the skills needed for this role are: Communicate well verbally and in writing to support and lead your team. Perform customer care duties to provide high levels of service. Execute merchandising strategies to support store sales growth. Manage the store inventory and assets to maintain profitability. We are invested in your growth and anticipate that you will be as well. We expect our SMIT's to: Actively engage with your leader in Key Learning Experiences to support you on your path to promotion during the structured program. Support your store as management team member and lead in a manner that is consistent with CVS values and p

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. The Store Manager In Training (SMIT) job is a development focused role that is crafted to prepare you for a CVS Store Manager position. The SMIT program is designed to enhance your career as a future store leader. We support your development towards the store manager role by participating in a self-paced, collaborative training over the span of 16 weeks. We provide both virtual and hands on learning experiences to develop you as a leader. Our team of people, that support your growth toward your leadership career include: your District Leader, Human Resources Business Partner, Training Store Manager, and your Store Manager coach. Some of the skills needed for this role are: Communicate well verbally and in writing to support and lead your team. Perform customer care duties to provide high levels of service. Execute merchandising strategies to support store sales growth. Manage the store inventory and assets to maintain profitability. We are invested in your growth and anticipate that you will be as well. We expect our SMIT's to: Actively engage with your leader in Key Learning Experiences to support you on your path to promotion during the structured program. Support your store as management team member and lead in a manner that is consistent with CVS values and p

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. The Store Manager In Training (SMIT) job is a development focused role that is crafted to prepare you for a CVS Store Manager position. The SMIT program is designed to enhance your career as a future store leader. We support your development towards the store manager role by participating in a self-paced, collaborative training over the span of 16 weeks. We provide both virtual and hands on learning experiences to develop you as a leader. Our team of people, that support your growth toward your leadership career include: your District Leader, Human Resources Business Partner, Training Store Manager, and your Store Manager coach. Some of the skills needed for this role are: Communicate well verbally and in writing to support and lead your team. Perform customer care duties to provide high levels of service. Execute merchandising strategies to support store sales growth. Manage the store inventory and assets to maintain profitability. We are invested in your growth and anticipate that you will be as well. We expect our SMIT's to: Actively engage with your leader in Key Learning Experiences to support you on your path to promotion during the structured program. Support your store as management team member and lead in a manner that is consistent with CVS values and p