Medical Scientist in United States

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 Oak Street Health takes a team-based approach to providing outstanding patient care. In partnership with various Service Operation leaders (Call Center, Third Party Services, Medical Records, Triage Nurse, Pharmacy Technicians, etc.) the Quality Supervisor helps us meet our goal of successfully managing the continuity of care for all of our patients. As a leader in Service Operations, this supervisor oversees a team of Quality and Issue resolution Specialists tasked with reviewing, analyzing, investigating and auditing service standards and processes. The Quality Supervisor will be an expert in Service Operation protocol, standards, and expectations, who is able to resolve escalated issues as well as perform daily supervisory functions such as team monitoring, motivating, recognizing, coaching, and training. In direct collaboration with the Service Operations Quality Manager, the Supervisor participates in staffing, managing, and engaging a team, in addition to supporting Service Operations in delivering timely, high quality care. Core Responsibilities: Directly supervises a team of Quality and Issue Resolution specialists, providing daily direction and communication to ensure quality audits and issues are completed in a timely, efficient, and accurate manner. Ensures all Specialists have the appropriate tra

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. 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

The starting pay range for this position per hour is $24.00 - $26.00. The full pay range for this position per hour is $24.00 - $40.80 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT PROPERTY MANAGEMENT Property Management suppo

The pay range is $64,000.00 - $128,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . ALL ABOUT HUMAN RESOURCES You are a team that champions change, proactively removes roadblocks and builds diverse and inclusive talent strategies to

The pay range is $95,000.00 - $205,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . A role with the Design team means a big opportunity to start from scratch and create something truly original. Are you a design expert who can support your business by st

The pay range is $95,000.00 - $171,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About Us Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . <span style="c

The pay range is $106,000.00 - $212,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. ALL ABOUT STORE LEADERSHIP You lead a team that has one purpose: to help all families discover the joy of everyday <s

The pay range is $83,200.00 - $130,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . ALL ABOUT HUMAN RESOURCES You are a team that champions change, proactively removes roadblocks and builds diverse and inclusive talent strategies to

The pay range per hour is $24.28 - $43.75 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: As a Fortune 50 company with more than 400,000 team members worldwide, Target is an iconic brand and one of America's leading retailers. ​ Working at Target means the opportunity to help all families discover the joy of everyday life. Caring for our communities is woven into who we are, and we invest in the places we collectively live, work and play. We prioritize relationships, f

The pay range is $64,000.00 - $128,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . ALL ABOUT SERVICE & ENGAGEMENT Advocates of guest experience who welcome, thank and exceed guest service expectations by focusing on guest intera

The pay range per hour is $17.98 - $30.48. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . Schedules: Saturday - Monday 7:00am-7:00pm Tuesday - Friday 4:00am - 2:00pm About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. <a target="_blank" href="https:

The pay range is $64,000.00 - $128,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . ALL ABOUT SPECIALTY SALES A sales force of specialized consultants who provide tailored suggestions and solutions through active selling and compell

The pay range is $64,000.00 - $128,000.00 Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . ALL ABOUT TARGET Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . ALL ABOUT SPECIALTY SALES A sales force of specialized consultants who provide tailored suggestions and solutions through active selling and compell