Quality Assurance Director 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. 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. If you're looking to make a global difference in your next role, this opportunity is for you. Aetna International is seeking an Analyst, Account Manager who is passionate about delivering an exceptional customer experience and supporting the ongoing success of our Access U.S. customers. In this role, you will partner with Account Managers, customers, brokers, and internal business partners to provide day-to-day operational and service support throughout the customer lifecycle. You will help drive customer satisfaction and membership retention through proactive coordination, accurate execution, consultative problem-solving, and timely issue resolution. The Access U.S. business provides comprehensive health benefit solutions for U.S.-based employees of multinational organizations. Through a range of medical plans, wellness programs, digital health tools, global support services, and dedicated account management, Access U.S. helps employers offer competitive benefits while providing members with access to high-quality care and a personalized health care experience. Position Summar y Supports the Account Management team in delivering a consistent, high-quality experience for Access U.S. customers, brokers, and members. Provides operational and administrative support across eligibility, enrollment, benefit documentation, customer service activities, and issue resolution. Collaborat

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. Requisition Job Description Position Summary The Director, Corporate Affairs Technology leads the strategy, delivery, and operations of technology solutions supporting Legal, Compliance, and Corporate Security functions. This role partners with Corporate Affairs leadership to enable regulatory compliance, risk management, and enterprise protection through modern, scalable, and AI-driven technology solutions. This position is a leader-of-leaders role , with direct oversight of Senior Managers and their teams, and is accountable for delivering business-aligned outcomes across the Corporate Affairs application portfolio. Key Responsibilities Define and execute the technology strategy and multi-year roadmap for Corporate Affairs (Legal, Compliance, Corporate Security) Serve as a strategic partner to business leadership, aligning technology solutions to legal, compliance, and security priorities Lead and develop Senior Managers and their teams , ensuring strong performance, accountability, and organizational growth Own the end-to-end application portfolio , including design, delivery, operations, and modernization of platforms Champion AI, automation, and advanced analytics solutions to transform legal, compliance,

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 Risk Management is charged with protecting company assets. This group is responsible for minimizing risk – in legal, financial and operational areas – and its affects on the organization, as well as for enforcing security and safety measures. Coordinate effective resolution of member and/or provider/practitioner appeals, complaints and grievances. Responsible for the day-to-day management of staff to ensure effective resolution of member or provider/practitioner appeals, complaints and grievances for all products, which may contain multiple issues and, may require coordination of responses from multiple business units. Ensure timely, customer focused response to appeals, complaints and grievance. Responsible for day-to-day implementation of Aetna's appeals, complaints and grievances policies and procedures. Identifies trends and issues; reports on and recommends solutions. Accountable for meeting the financial, operational, and quality objectives of the unit. -Manages team's productivity and resources, communicates productivity expectations and balances workload to achieve customer satisfaction through prompt/accurate handling of customer concerns. -Serves as a content model expert and mentor to team regarding Aetna's policies and procedures, regulatory and accreditation req

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan

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 Purpose and 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 Pharmacy Managers play a critical role in cultivating a culture of excellence in their respective pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for their pharmacy team. As a Pharmacy Manager, you will lead and develop a pharmacy team that provides exceptional patient care by promoting best practices and leading through change while identifying and addressing performance opportunities. Pharmacy Managers support novel program awareness, onboard newly hired pharmacy team members, and recognize colleagues for their success. The Pharmacy Manager consistently exhibits best practices when working the bench, including quarterbacking the team, providing patients with meaningful counseling, and abiding by all legal and regulatory guidelines, amongst other required activities. The Pharmacy Manager is responsible for direct and effective management of their pharmacy team, including but not limited to: Living our pur

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan

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 Purpose and 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 Staff Pharmacists play a critical role in cultivating a culture of excellence in their pharmacy by acting as a role model for all, demonstrating genuine care, and setting the bar for the pharmacy team. As a Staff Pharmacist, you play a critical role at the forefront of delivering our purpose, modeling our values, and demonstrating genuine, authentic care for our patients. In addition to supporting the Pharmacy Manager in leading and directing the pharmacy team, you are accountable for supporting the management, oversight, and operation of all aspects within your pharmacy. The Staff Pharmacist’s responsibilities include, but are not limited to: Living our purpose by helping to manage and improve patient health through safe and appropriate dispensing, counseling, and immunizing practices Taking direction from the Pharmacy Manager and overseeing the pharmacy as their proxy during bench shifts without overlap, including strengthening pharmacy performan