Provider Data Services Specialist in Tx Work From Home

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 Analyst, Plan Sponsor Services Technician is responsible for entering and maintaining client and provider information within internal systems, ensuring data accuracy and completeness. This role supports ongoing updates for new, terminated, and modified client records, validates required documentation, participates in process and audit review meetings, and consistently meets monthly accuracy and quality standards. Required Qualifications 2-4 years of Health insurance industry experience. 2-4 years of experience maintaining client and provider data within healthcare or insurance systems. 2-4 years of experience supporting plan sponsors, or provider networks. Experience working in a fast-paced administrative or operational environment. Strong attention to detail with a proven ability to maintain data accuracy. Preferred Qualifications Managed Care experience Associate's degree preferred. Education High School Diploma or GED required. Anticipated Weekly Hours 40 Time Type Full time <p style="t

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 Join us at the start of a new era in health care where technology is transforming how and where care is delivered, creating a more connected, effective care experience for all. Our mission at Signify Health is to build trusted relationships to make people healthier. We do this by transforming the home into a health hub through a combination of data, technology & people. We are building a unified technology platform for value-based care that is improving care and reducing spending by treating patients in lower-cost settings and linking providers’ payments to patient outcomes. Signify Health is driving this industry transformation and solving some of the most challenging problems in healthcare – this is where you come in! About the Role As a Staff Software Engineer, you’ll be a key member of a collaborative team responsible for design, delivery and operation of business-critical, distributed systems. We’re looking for technically strong, passionate people with an entrepreneurial spirit to build and sustain innovative solutions. Required Qualifications 7 years of software development experience. Strong foundation in software engineering: problem solving, data structures, algorithms, patterns, concurrency. Experience as a polyglot soft

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Join us at the start of a new era in health care where technology is transforming how and where care is delivered, creating a more connected, effective care experience for all. Our mission at Signify Health is to build trusted relationships to make people healthier. We do this by transforming the home into a health hub through a combination of data, technology & people. We are building a unified technology platform for value-based care that is improving care and reducing spending by treating patients in lower-cost settings and linking providers’ payments to patient outcomes. Signify Health is driving this industry transformation and solving some of the most challenging problems in healthcare – this is where you come in! About the Role As a Senior Software Engineer, you’ll be a key member of a collaborative team responsible for design, delivery and operation of business-critical, distributed systems. We’re looking for technically strong, passionate people with an entrepreneurial spirit to build and sustain innovative solutions. Basic Qualifications 5 years of software development experience. Strong foundation in software engineering: problem solving, data structures, algorithms, patterns, concurrency. Strong understanding and demo

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–6:00pm 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 Author

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. Medicare Precertification Utilization Management Nurse Consultant (RN) Remote | Full-Time | Weekends Are you a detail-oriented RN passionate about improving healthcare outcomes? Join our Utilization Management team and play a key role in ensuring members receive the right care at the right time. What You’ll Do Review and assess clinical information to support coverage determinations Apply clinical guidelines, policies, and sound judgment across the care continuum Collaborate with providers and care teams to coordinate treatment plans Identify opportunities to enhance quality, efficiency, and member outcomes Refer members to additional programs and services as appropriate Serve as a clinical resource within utilization/benefit management Schedule Training: Monday–Friday, 8:30 AM–5:00 PM (EST) After training: 4-day WEEKEND schedule (Friday–Monday, 10-hour shifts) Includes evening hours and occasional holidays (24/7 operation) Required Qualifications Active, unrestricted RN license in state of residence 3&#43; years of RN experience 1&#43; year Med/Surg experience Proficiency with Microsoft Office (Outlook, Teams, Excel) Willingness to work required schedule post-training Preferred Qualifications <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 Introduction & Overview In this role, you will be an integral part of the account support team, working alongside the Client Success Executive/Manager and Client Operations Owner (COO) to ensure seamless operational execution for our health plan partners. You will provide dedicated administrative and operational support across assigned accounts—managing meeting cadences, capturing key deliverables, and maintaining client communication workflows. You will provide dedicated operational and administrative support for one or two large client accounts or a portfolio of smaller health plan clients alongside Client Success and Client Operations leads Roles & Responsibilities: Act as the Subject Matter Expert (SME) and operational owner for member journey processes and client collateral, guiding clients through process requirements, implementing requested updates, resolving ad-hoc inquiries, tracking open action items, and ensuring timely follow-through Own the end-to-end meeting documentation process for both client-facing calls and internal team syncs, including preparing and circulating agendas and decks, capturing comprehensive meeting minutes, and tracking action items Capture, document, and track open items and deliverables resulting from client meetings and ongoing email correspondence Manage routine ad-hoc client inquirie

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. Remote RN Case Manager (Case Management & Utilization Management) Aetna National Medical Excellence (NME) is seeking an experienced Registered Nurse (RN) Case Manager to join our growing team. This is a fully remote opportunity open to candidates nationwide, with preference given to nurses residing in compact licensure states . In this blended role, you will combine Case Management and Utilization Management expertise to support members with complex healthcare needs. You'll partner with members, providers, and interdisciplinary teams to develop personalized care plans, improve health outcomes, reduce barriers to care, and promote overall wellness. What You'll Do Assess, coordinate, and manage care for members with complex medical needs Develop proactive care plans to improve short- and long-term health outcomes Identify clinical, social, and functional barriers impacting care Collaborate with healthcare providers and multidisciplinary teams Utilize clinical judgment to support effective utilization and care management decisions Engage members through telephonic care management and health coaching Required Qualifications Active, unrestricted Compact RN license in state of residence 5&#43; years of RN clinical practice experience 2&#43;

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 Location: EST and/or CST Work Schedule: Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Position Summary: Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifi

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. ••work from Home- Candidate may reside in Texas or Arizona•• At CVS Health, we believe we can change the world by improving patient lives, one call at a time. Our Telephonic Registered Nurses (RN) have patient contact in the uniqueness of a telephonic practice setting, where they are impacting lives across the country. You will continue to experience the reasons you became a nurse without having to be in a bedside patient care environment. Working from home, you will be part of a specialized team on the cutting edge of patient care. Working collaboratively with health care professionals, you will provide a meaningful patient experience, while using your critical thinking skills to develop, implement, and evaluate comprehensive plans of care for multiple disease state patients. As a Telephonic Registered Nurse, you will a profound effect on the lives of the patients and caregivers via each outbound call, providing education and support for their new medication. Along with the Compliance and Persistency team, you are the continuity of care supporting defined patient populations through the use of our state-of-the-art telecommunications nursing outreach programs. To be successful in this Registered Nurse position, you must have excellent written and verbal customer service skills, as well as advanced computer skills in order to interact with patients. Our Registered Nurses redefine the way

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 Our team owns the foundational AI/GenAI platform services that power CVS Health's internal agentic and LLM-driven tooling — including LLM routing and cost governance infrastructure, internal developer tooling for AI-assisted software development, retrieval-augmented generation (RAG) capabilities, and orchestration tools for building and deploying agentic workflows. We sit at the intersection of platform engineering and applied GenAI: we're responsible for making it fast, safe, and cost-effective for engineering teams across the enterprise to build with LLMs, while navigating the compliance realities of operating in a healthcare environment (PHI/PII handling, HIPAA, BAA requirements with model providers). This role will design and build core platform services — spanning areas like auth, quota/cost management, observability, and routing policy — and will help define what our next generation of foundational AI services looks like as the GenAI landscape evolves. The team is deeply senior and highly collaborative; we're looking for someone who brings genuine, self-driven enthusiasm for this space — someone who explores new ideas and tools because they're excited to, not because they were asked to — while working closely with the rest of the team to bring those ideas to life. Required Qualifications 5&#43; years of professional software engineering experience, i