Excel Specialist in United States

Job Title INR Enrollment Representative Job Description As the INR Enrollment Representative , you will be the first point of contact for new patients in the International Normalized Ratio (INR) testing program, helping them start their health journey with confidence and support. Your role: Receiving, processing, and entering new patient order forms and faxed enrollments into the system, following up with practices and patients via phone or email to obtain missing information. Contacting new patients to confirm insurance coverage and provide out-of-pocket cost estimates based on insurance responses. Managing both outbound and inbound calls through the patient and clinic call center, consistently meeting quality, accuracy, and performance standards. Scheduling remote INR testing training with contracted nurse trainers. This role requires working Monday-Friday between 9:30am-6:00pm EST. You're the right fit if: You’ve acquired 1&#43; years of experience in data entry, customer service or a call center. Experience within the medical field and knowledge of Protected Health Information (PHI) or HIPAA is preferred. Your skills include: Proficiency in Microsoft Office applications including Word, Excel and Teams. Excellent technical acumen, and the ability to efficiently navigate multiple technical platforms simultaneously while adapting to change with ease. You have a high school diploma, vocational education or a General Education Diploma (GED). You must be able to successfully perform the following minimum Physical, Cognitive and Environmental job requirements with or without accommodation for this <a target="_blank" href="https://eur01.safelinks.protection.outlook.com/?url&#61;https%3A

We’re here for one reason and one reason only – to cure cancer. Every moment is dedicated to developing treatments and every action moves us one step closer to our goal. We’ve made incredible scientific breakthroughs and our pioneering personalized CAR T-cell therapies have changed the paradigm. But we're not finished yet. Join Kite, as we make even bigger advances in cancer therapies, and help shape where our business and medical science goes next. We believe every employee deserves a great leader. People Leaders are the cornerstone to the employee experience at Gilead and Kite. As a people leader now or in the future, you are the key driver in evolving our culture and creating an environment where every employee feels included, developed and empowered to fulfil their aspirations. Join Kite and help create more tomorrows. Job Description An exciting opportunity has arisen to join the U.S. Medical Affairs Team with a focus on Lymphoma & Leukemia. In this role, you will contribute to one of the recent, most impactful medical advancements in patient care and will work towards better outcomes for patients with hematological malignancies. We are seeking a highly motivated individual to join our U.S. Medical Affairs team as an Associate Director, to support our lymphoma franchise. This role will work cross-functionally with multiple stakeholders including: Field Medical, Commercial, Market Access, HEOR/RWE and Global Medical Affairs, along with other cross-functional subject matter experts and key business partners to implement on tactics consistent with overall in-line and pipeline strategy. This position will report to the U.S. Lymphoma Medical Strategy Lead. Position will be filled and report into Foster City, CA, El Segundo, CA, 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: This is an individual contributor role. The Senior Manager negotiates, executes, conducts high level review and analysis, dispute resolution and/or settlement negotiations of contracts. Works with larger and more complex, market/regional/national based groups/systems in accordance with company standards to maintain and enhance provider networks while meeting and exceeding accessibility, quality and financial goals and cost initiatives. The Senior Manager will be responsible for contracting and implementing fee for service and value-based agreements with key physician groups, facilities, and ancillary providers to support commercial and individual exchange networks. This person will also work collaboratively with Aetna and CVS departments to identify initiatives to improve physician performance and quality of care provided to our members. Recruits providers as needed to ensure attainment of network expansion and adequacy targets. Accountable for cost arrangements within defined groups. Collaborates cross-functionally to manage provider compensation and pricing development activities, submission of contractual information, and the review and analysis of reports as part of negotiation and reimbursement modeling activities. What You’ll Do Lead end-to-end contract negotiations, execution, and analysis with a focus on hospital, ph

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 Location: Work From Home – Flexible, Travel Required: 25 – 50% (Wayne and Macomb Counties) Schedule: Standard business hours Monday-Friday 8:00am-5:00pm EST No evenings, weekends, or major holidays 4 day/10-hour schedule available after training ​ Our Mission The LTSS RN Case Manager is responsible for comprehensive assessment, care planning, coordination, implementation, and monitoring of Long-Term Services and Supports (LTSS) for dual-eligible Medicare and Medicaid members. This role ensures members receive appropriate waiver and community-based services to promote safety, independence, and improved health outcomes while maintaining regulatory compliance. This position includes in-home visits to complete functional assessments, evaluate eligibility for waiver services, and develop person-centered service plans. Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and

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 (RN) - Utilization Management Location: Remote (Preference for candidates in Central or Eastern Time Zones) Schedule: 24/7 operation; includes evenings, weekends, and holidays Are you an experienced Registered Nurse looking to leverage your clinical expertise in a collaborative, fast-paced environment? Join our Utilization Management team and play a critical role in ensuring members receive appropriate, high-quality healthcare services across the continuum of care. What You'll Do Review and assess clinical information to support coverage determinations and care recommendations. Apply clinical guidelines, policies, and professional judgment to utilization management decisions. Collaborate with providers and interdisciplinary teams to coordinate care and treatment plans. Identify opportunities for care management referrals and enhanced member support services. Promote quality outcomes, effective healthcare utilization, and member-centered care. Serve as a clinical resource for internal and external stakeholders. Required Qualifications Active, unrestricted RN license in your state of residence. 2&#43; years of RN experience in adult acute care or critical care settings. Associate Degree in Nursing (ADN). Strong communication, critica

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 position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. - One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. - Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. - Establishes and maintains communicat

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. Registered Nurse (RN) – Utilization Management Remote | Work from Home | Eastern Time Zone Preferred Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy. What You'll Do Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs and resources that support their healthcare needs Serve as a clinical resource for internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2&#43; years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and decision-making skills Excellent verbal and written communication skills Ability to multitask and

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 (RN) – Utilization Management Remote | Work from Home | Eastern Time Zone Preferred Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right time through evidence-based clinical review, care coordination, and healthcare advocacy. What You'll Do Review clinical information and apply established guidelines, policies, and clinical judgment to support coverage determinations Assess, coordinate, monitor, and evaluate healthcare services and benefits across the continuum of care Collaborate with providers and care teams to facilitate appropriate treatment and care planning Identify opportunities to improve quality of care, member outcomes, and healthcare utilization Connect members with additional programs and resources that support their healthcare needs Serve as a clinical resource for internal and external stakeholders WHAT YOU BRING - REQUIRED Active, unrestricted RN license in your state of residence 2&#43; years of adult acute care and/or critical care nursing experience Strong clinical assessment, critical thinking, and decision-making skills Excellent verbal and written communication skills Ability to multitask and

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 Supervisor, Clinical Health Services is responsible for oversight of healthcare management staff, including the organization and development of high performing teams. In this role, you will: Oversee a non-clinical DE staff Work closely with functional area managers to ensure consistency in clinical interventions supporting our members. Be accountable for meeting the financial, operational and quality objectives of the unit. Oversee the implementation of healthcare management services for assigned functional area. Implement clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA [ National Committee for Quality Assurance ], URAC [ Utilization Review Accreditation Commission ], state and federal standards, and mandates as applicable). Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking. Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care. May act as a liaison with other key business areas. May develop/assist in development and/review new training content. May collaborate/deliver inter and intra-departme

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

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: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day. Our 3rd year Pharmacy Interns play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise, while developing their own skills in preparation for increasing responsibility. As a 3rd year Pharmacy Intern, you will be focused on applying didactic learning from pharmacy school into real-world practice to become ready for a Pharmacist role. Under the direction of your preceptor, you will complete a comprehensive training roadmap designed to show you first-hand what it’s like to be part of a pharmacy team while gaining an overview of store, district, and regional operations. You will gain valuable hands-on experience through a training roadmap that includes a combination of Key Learning Experiences (KLEs), activities, and time spent with leaders in your district. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. You will learn to operate as part of the pharmacy team through consistent application of Standard Op

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: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day. Our 3rd year Pharmacy Interns play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise, while developing their own skills in preparation for increasing responsibility. As a 3rd year Pharmacy Intern, you will be focused on applying didactic learning from pharmacy school into real-world practice to become ready for a Pharmacist role. Under the direction of your preceptor, you will complete a comprehensive training roadmap designed to show you first-hand what it’s like to be part of a pharmacy team while gaining an overview of store, district, and regional operations. You will gain valuable hands-on experience through a training roadmap that includes a combination of Key Learning Experiences (KLEs), activities, and time spent with leaders in your district. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. You will learn to operate as part of the pharmacy team through consistent application of Standard Op

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: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day. Our 3rd year Pharmacy Interns play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise, while developing their own skills in preparation for increasing responsibility. As a 3rd year Pharmacy Intern, you will be focused on applying didactic learning from pharmacy school into real-world practice to become ready for a Pharmacist role. Under the direction of your preceptor, you will complete a comprehensive training roadmap designed to show you first-hand what it’s like to be part of a pharmacy team while gaining an overview of store, district, and regional operations. You will gain valuable hands-on experience through a training roadmap that includes a combination of Key Learning Experiences (KLEs), activities, and time spent with leaders in your district. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. You will learn to operate as part of the pharmacy team through consistent application of Standard Op