Jobs at CVS Health

Negotiate, execute, review, and analyze contracts with solo, small group, and local providers to support network development, adequacy, quality, and cost objectives. Manage contract performance, recruit providers, collaborate cross-functionally on pricing and reimbursement modeling, identify cost-saving opportunities, resolve escalated contract or claims issues, and support strategic network configuration and integration activities.

Lead negotiation, execution, and analysis of complex provider contracts for regional/national networks, recruit providers to meet network adequacy goals, manage contract lifecycle in contract management systems, develop pricing and reimbursement models, and present findings to leadership while supporting behavioral health network initiatives.

Manage and negotiate provider contracts across Florida, implement value-based relationships, recruit providers to meet network targets, analyze provider data for reimbursement modeling, drive cost-saving initiatives, collaborate cross-functionally on compensation and contract issues, and resolve escalations related to claims or contract interpretation.

Serve as the primary contact for assigned providers, build and maintain long-term relationships, resolve complex issues involving policies, plan design, contracts, and claims, collaborate with internal partners to resolve escalations, deliver consistent provider education and operational excellence, and recommend process improvements based on service trends.

Develop and deploy AI-powered analytics and predictive models for call center operations using data mining, NLP, and machine learning. Design data solutions, dashboards, and metrics; communicate findings to stakeholders; ensure data governance compliance and continuously adopt modern analysis and visualization tools to improve healthcare quality and operational efficiency.

Assess, coordinate, and evaluate member care using clinical judgment and utilization criteria to render coverage determinations. Communicate with providers, identify referral opportunities, promote quality and appropriate benefit utilization, and document decisions while meeting productivity and quality expectations in a 24/7 utilization management environment.

Lead diligence, financial modeling, and deal execution for mid/late-stage growth investments. Source and evaluate opportunities, support portfolio companies, prepare executive materials, and partner with senior leaders to align investment theses with CVS Health strategic priorities.

Design, develop, and maintain backend services and APIs for an AI-native health platform. Lead technical designs, ensure engineering excellence, manage release cycles, collaborate across teams, drive operational excellence, and support production monitoring, incident triage, and deployment readiness.

Design, develop, and maintain scalable backend services and APIs using Java, Spring Boot and Node.js. Contribute to architecture, implement cloud-native, containerized solutions on Kubernetes, apply observability, integrate systems, deliver AI-enabled features, mentor engineers, conduct code reviews and support production deployments within Agile teams.

Design, develop, and support Apptio-based IT financial management solutions, manage chargeback processes, integrate enterprise data, improve automation and performance, and support monthly IT cost allocations while mentoring team members.

Lead end-to-end analytics and ML initiatives for PBM member engagement: build, deploy, and monitor large-scale ML/DL models; perform EDA and data quality assessments on prescription claims; collaborate with engineering and stakeholders to create feature stores and MLOps pipelines; communicate results to business leaders; mentor peers and interns.

Design, build, and maintain distributed data platform components (messaging, DB, data warehouse), automate provisioning/backups, troubleshoot performance/reliability, participate in on-call rotation, mentor junior engineers, and contribute to the technical roadmap and platform improvements.

Remote Proposal Quality Analyst responsible for structured quality reviews of RFP responses, ensuring compliance with Aetna style and bid guides. Collaborates with writers and SMEs, uses editing/collaboration tools, supports quality governance, develops scorecards/reports, and drives continuous improvement. Requires Medicaid knowledge and ability to work extended hours and travel for proposal periods.

Lead strategy, discovery, and execution for a G&A value stream, translating business and customer problems into prioritized product roadmaps. Partner with engineering, design, data, and stakeholders to deliver measurable outcomes, drive cross-functional alignment, and coach product practices while operating in ambiguous, enterprise healthcare environments.

Provide value-based primary care to Medicare adults: independent office visits, annual wellness and acute care, care coordination, population health activities, patient education, phone triage, occasional home visits, and participation in clinic outreach and promotions.

Design, deploy, and operate enterprise SDN and traditional network infrastructure. Create network designs, implement deployments, provide Level 4 support, establish testing strategies, and maintain SDN documentation. Work with stakeholders, manage projects, perform routing/switching, troubleshooting, monitoring, security, and automation using scripting, Python, and Ansible to improve resilience and reduce operational costs.

Lead and scale the proposal quality function for Medicaid proposals by defining strategy, standards, metrics, and tools. Drive data-informed improvements, cross-functional alignment, team development, continuous improvement, and adoption of AI-enabled tools to deliver compliant, compelling proposals on time.

Manage provider contracting and value-based relationships to meet network adequacy and cost targets. Lead negotiations, analyze reimbursement models, drive cost-savings initiatives, recruit providers, resolve escalated contract/claims issues, and collaborate cross-functionally on pricing, compensation, and strategic network plans. Requires project management, provider engagement, and performance monitoring to support state contract and product requirements.

Design, build, and maintain enterprise Tableau dashboards and BigQuery data models; perform SQL-based analysis and validation; enable AI-assisted insights and automated reporting using GCP tools; ensure governance, security, and compliance in healthcare/PBM contexts; partner with stakeholders and data engineering to standardize metrics and deliver executive-ready narratives.

Provide clinical and distributive pharmacy services for specialty disease states (HIV, Hep-C, Oncology, RA). Verify medications, manage patients clinically, triage complex issues, lead daily team activities, support clinical and sales initiatives, and ensure compliance with standards, SOPs, and regulations.