CrawlJobs Logo

Analyst, Care Management Specialist

https://www.cvshealth.com/ Logo

CVS Health

Location Icon

Location:
United States , Work at Home

Category Icon
Category:
-

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

21.10 - 36.78 USD / Hour

Job Description:

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. As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members’ needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care.

Job Responsibility:

  • Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care
  • Member Outreach: Utilize all available resources to connect with and engage “hard-to-reach” members
  • Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs
  • Documentation: Maintain meticulous documentation of care management activities in the member’s electronic health record
  • Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition
  • Resource Connection: Identify and connect members with health plan benefits and community resources
  • Regulatory Compliance: Meet regulatory requirements within specified timelines
  • Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making
  • Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed
  • Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members

Requirements:

  • 2+ years of experience in a health-related field
  • 2+ years of customer service experience
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams)
  • Access to a private, dedicated space to conduct work effectively
  • Associate’s degree with relevant experience in a health care-related field OR Practical Nurse degree/certificate with active state licensure

Nice to have:

  • Experience providing care management for Medicare and/or Medicaid members
  • Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
  • Experience conducting health-related assessments and facilitating the care planning processes
  • Bilingual skills, especially English-Spanish
  • Bachelor’s degree in healthcare or a related field
What we offer:
  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

Additional Information:

Job Posted:
March 22, 2026

Expiration:
March 28, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Analyst, Care Management Specialist

Specialist IS Business Systems Analyst - Product Team

In this vital role you will join the Revenue Management Product Team in Amgen’s ...
Location
Location
United States
Salary
Salary:
117162.00 - 144885.00 USD / Year
amgen.com Logo
Amgen
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Doctorate degree
  • OR Master’s degree and 2 years of Information Systems experience
  • OR Bachelor’s degree and 4 years of Information Systems experience
  • OR Associate’s degree and 8 years of Information Systems experience
  • OR High school diploma / GED and 10 years of Information Systems experience
Job Responsibility
Job Responsibility
  • Serves as the Product Owner and Lead Business Analyst for Amgen’s Model N Revenue Cloud SaaS implementations, with responsibility for the full cycle of service delivery
  • Owns stakeholder relationships with cross-functional business and DTI partners to translate, negotiate, and influence business needs into technology product solutions
  • Evaluates needs, researches, and helps design and engineer product capabilities and process workflows to enable integrated contract development, operations, and financial reporting with improved transparency and auditability
  • Establishes and maintains system capabilities and governance to ensure data integrity across the technology landscape
  • Manages the full lifecycle of product features using SAFe principles from product visioning through DevOps
  • Supports product leadership with project management, planning, resourcing (both internal and external), prioritization, and funding for product capabilities
  • Provides key Product Owner and Business Analyst support for Amgen’s implementation and operations of the Model N Pharma Revenue Cloud SaaS platform, including data management for master data (products, pricing, contracts, customers, and memberships), contracts, strategies, and rebates and fee transactions for payer (managed care), channel, and provider rebates
  • Works cross-functionally with Client Facing IT, Commercial, and Finance stakeholders to support data integrations and workflows necessary for forecasting, reporting, and analytics capabilities across Amgen’s Gross-to-Net processes
  • Works with business partners, end users, and technology teams to capture, understand, and define business requirements
  • Partners with Product and Enterprise IT teams to build and validate technology solutions, workflows, and process automation, including automated regression testing
What we offer
What we offer
  • A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
  • A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
  • Stock-based long-term incentives
  • Award-winning time-off plans
  • Flexible work models, including remote and hybrid work arrangements, where possible
  • Fulltime
Read More
Arrow Right

Contract Compliance Analyst III

The Contract Compliance Analyst III will facilitate contract implementation and ...
Location
Location
United States , Madison
Salary
Salary:
51000.00 - 84000.00 USD / Year
exactsciences.com Logo
Exact Sciences
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 3+ years of experience in billing/reimbursement, coverage, claims, and appeals
  • Demonstrated understanding of public and private Managed Care payers and reimbursement process
  • Demonstrated understanding of market-related issues, contract basics, product coverage, and pull through rationale
  • Proficient with Excel and Epic or similar database
  • demonstrated ability to maintain competency levels
  • Demonstrated ability to perform the Essential Duties of the position with or without accommodation
  • Applicants must be currently authorized to work in country where work will be performed on a full or part-time basis. We are unable to sponsor or take over sponsorship of employment visas at this time.
Job Responsibility
Job Responsibility
  • Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers and collaborate with the Field Managed Care team in negotiations with payers for operational optimization
  • Play a role in the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams
  • Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments
  • including Medicare Advantage, Blues, Medicaid, etc.
  • Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual
  • Support execution of pull-through plans to meet quarterly/annual revenue recovery goals
  • Identify broad revenue opportunities that span a particular customer segment
  • including utilizing Content Management Systems (CMS) for noncontracted Managed Medicare non-payments and the Employer Coalition initiative
  • Consistently identify opportunities to recover revenue
  • Collaborate with the Managed Care team to identify and prioritize plan(s) utilizing key payers for targeted efforts to impact coverage policy decisions
What we offer
What we offer
  • paid time off (including days for vacation, holidays, volunteering, and personal time)
  • paid leave for parents and caregivers
  • a retirement savings plan
  • wellness support
  • health benefits including medical, prescription drug, dental, and vision coverage
  • bonus eligible.
  • Fulltime
Read More
Arrow Right

Head of Positive Behaviour Support

Optimo Care Group is seeking an experienced and passionate Head of Positive Beha...
Location
Location
United Kingdom , Colchester; Clacton; Ilford
Salary
Salary:
50000.00 - 60000.00 GBP / Year
jobs.360resourcing.co.uk Logo
360 Resourcing Solutions
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • MSc in Applied Behaviour Analysis, Positive Behaviour Support, Intellectual and Developmental Disabilities, or equivalent
  • UKBA (Cert) and current UKSBA membership
  • Minimum of 3 years’ experience in a senior PBS role
  • Experience providing clinical supervision and line management within PBS teams
  • Experience leading the implementation of a service-wide PBS approach
  • Experience supporting individuals with high-risk behaviours of concern
  • Strong skills in functional assessment, PBS plan development and behavioural intervention
  • Excellent written and verbal communication skills
  • Strong clinical judgement in complex situations
  • Excellent organisational and time management skills
Job Responsibility
Job Responsibility
  • Develop and implement the Positive Behaviour Support strategy across CFT Care and Spectra Care
  • Work collaboratively with senior leadership and operational teams to embed PBS across services
  • Analyse service data and feedback to monitor effectiveness and identify areas for improvement
  • Support the development of PBS-related policies, systems and training programmes across both organisations
  • Provide line management, clinical supervision, mentoring and coaching to Behaviour Analysts and PBS Practitioners
  • Support Behaviour Analysts with the management and development of PBS Champions
  • Maintain clinical oversight of all PBS cases across services
  • Ensure the PBS team works in line with the latest research, guidance and best practice
  • Provide specialist behavioural support for individuals presenting high-risk behaviours of concern
  • Conduct Functional Behaviour Assessments and develop Positive Behaviour Support plans
  • Fulltime
Read More
Arrow Right

Wealth Advisor

The Wealth Advisor focuses on deepening relationships with an established base o...
Location
Location
United States , New York City
Salary
Salary:
200000.00 - 250000.00 USD / Year
flexprofessionalsllc.com Logo
FlexProfessionals
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree from an accredited institution (preferably Business, Economics, Accounting or Finance related)
  • At least 7 years of job-related experience (Independent Advisor, Registered Representative, Securities Portfolio Manager, Financial Planner, Certified Public Accountant)
  • Certified Financial Planner (CFP) designation required. In lieu of the CFP, the following certifications may be acceptable: Chartered Financial Consultant (ChFC), Personal Financial Specialist (PFS), Chartered Financial Analyst (CFA), Chartered Investment Consultant (CIC)
  • Series 65 required, unless any of the above designations qualify for an exemption in the applicable state(s)
  • Advanced knowledge of the industry, financial products, and financial planning concepts
  • Superior communication skills
  • Advanced knowledge of the economic landscape/general understanding of impact on the Firm and clients
  • Experience utilizing financial planning software
  • Expert at collaboration and willing to help others
  • Strong core understanding of investments, along with the ability to perform asset allocation and analysis for portfolio reviews
Job Responsibility
Job Responsibility
  • Partners with affluent clients to identify their financial goals, analyze their financial landscape and develop recommendations that help them work towards well defined financial objectives
  • Communicates complex financial solutions to clients, utilizing interpersonal communication and relationship building skills
  • Ensures client retention by building meaningful and long-lasting relationships, alongside the development and implementation of appropriate financial solutions
  • Leverages the firm's broad set of solutions including tax, estate planning, insurance, and more to provide a comprehensive offering to our clients
  • Ensures adherence to compliance and regulatory policies as well as company standards of client care
  • Acts as a fiduciary, placing client interests and outcomes first
What we offer
What we offer
  • Competitive benefits including health/dental/vision and 401 K
  • Additional benefits include employee assistance programs, wellness programs, parking, commuter benefits, and life insurance
  • Fulltime
Read More
Arrow Right

Agentforce Specialist - AI Solutions

We are looking for an Agentforce Specialist to join our team and contribute to t...
Location
Location
Italy , Assago
Salary
Salary:
Not provided
https://www.soprasteria.com Logo
Sopra Steria
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Minimum of 6 months hands-on experience with Agentforce
  • solid background as a Salesforce Developer is essential, with practical experience in Apex, LWC, and Salesforce Flow
  • technical skills required: Agentic AI Gen, Salesforce CRM, Salesforce Service Cloud, Salesforce Agentforce, Salesforce Data Cloud, Apex, LWC (Lightning Web Components), Salesforce Flow
  • degree in a STEM field
  • good command of the English language
  • strong communication and collaboration skills
  • problem-solving mindset, sense of responsibility, autonomy, and a team-oriented approach
Job Responsibility
Job Responsibility
  • Designing, developing, and deploying Agentforce-based solutions
  • creating agents, flows, topics, and actions
  • using the Agent Builder to manage and deliver Agentic AI solutions
  • creating and managing prompts in Prompt Builder aligned with Agentic AI and Einstein Generative AI best practices
  • leveraging SKU Agentforce for Service to support Customer Care and ticket management
  • developing and integrating agents into external websites
  • working with structured and unstructured data in Salesforce Data Cloud
  • leading the technical aspects of AI projects and mentoring junior team members
  • collaborating with developers and business analysts to understand AI requirements
What we offer
What we offer
  • Opportunity to work in a dynamic environment
  • work on national and international projects
  • continuously expand knowledge and develop skills
  • smart-working agreement according to company policy
  • availability to travel nationally and internationally required
  • Fulltime
Read More
Arrow Right

Senior Wealth Advisor

The Partner, Market Leader is a player/coach who acts as a senior wealth advisor...
Location
Location
United States , Chicago
Salary
Salary:
300000.00 USD / Year
flexprofessionalsllc.com Logo
FlexProfessionals
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree from an accredited institution (preferably Business, Economics, Accounting or Finance related)
  • 10+ years of job-related experience
  • Certified Financial Planner (CFP) designation required. In lieu of the CFP, the following certifications may be acceptable: Chartered Financial Consultant (ChFC), Personal Financial Specialist (PFS), Chartered Financial Analyst (CFA), Chartered Investment Consultant (CIC)
  • Series 65 required, unless any of the above designations qualify for an exemption in the applicable state(s)
  • Advanced knowledge of the industry, financial products, and financial planning concepts
  • Superior communication skills, with the ability to effectively present investment, finance, and tax planning solutions to clients
  • Advanced knowledge of the economic landscape/general understanding of impact on the Firm and clients
  • Experience utilizing financial planning software
  • Expert at collaboration and willing to help others
  • Strong core understanding of our investments and ISG, along with the ability to perform asset allocation and analysis for portfolio reviews
Job Responsibility
Job Responsibility
  • Partners with affluent clients to identify their financial goals, analyze their financial landscape and develop recommendations that help them work towards well defined financial objectives
  • Communicates complex financial solutions to clients, utilizing interpersonal communication and relationship building skills
  • Ensures client retention by building meaningful and long-lasting relationships, alongside the development and implementation of appropriate financial solutions
  • Leverages the firm’s broad set of solutions including tax, estate planning, insurance, and more to provide a comprehensive offering to our clients
  • Ensures adherence to compliance and regulatory policies as well as company standards of client care
  • Acts as a fiduciary, placing client interests and outcomes first
  • Acts as a senior wealth advisor while leading a small team of other advisors
  • Focuses on deepening relationships with an established base of high-net-worth clients and organically growing their practice through referrals
  • Plays a key role in apprenticing and developing advisor team members to maximize client excellence and growth
What we offer
What we offer
  • Competitive benefits including health/dental/vision and 401 K
  • Additional benefits include employee assistance programs, wellness programs, parking, commuter benefits, and life insurance
  • Fulltime
Read More
Arrow Right

Partner, Senior Wealth Advisor

The Partner, Market Leader is a player/coach who acts as a senior wealth advisor...
Location
Location
United States , Detroit
Salary
Salary:
170000.00 - 300000.00 USD / Year
flexprofessionalsllc.com Logo
FlexProfessionals
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree from an accredited institution (preferably Business, Economics, Accounting or Finance related)
  • 10+ years of job-related experience
  • Certified Financial Planner (CFP) designation required. In lieu of the CFP, the following certifications may be acceptable: Chartered Financial Consultant (ChFC), Personal Financial Specialist (PFS), Chartered Financial Analyst (CFA), Chartered Investment Consultant (CIC)
  • Series 65 required, unless any of the above designations qualify for an exemption in the applicable state(s)
  • Advanced knowledge of the industry, financial products, and financial planning concepts
  • Superior communication skills, with the ability to effectively present investment, finance, and tax planning solutions to clients
  • Advanced knowledge of the economic landscape/general understanding of impact on the Firm and clients
  • Experience utilizing financial planning software
  • Expert at collaboration and willing to help others
  • Strong core understanding of our investments and ISG, along with the ability to perform asset allocation and analysis for portfolio reviews
Job Responsibility
Job Responsibility
  • Partners with affluent clients to identify their financial goals, analyze their financial landscape and develop recommendations that help them work towards well defined financial objectives
  • Communicates complex financial solutions to clients, utilizing interpersonal communication and relationship building skills
  • Ensures client retention by building meaningful and long-lasting relationships, alongside the development and implementation of appropriate financial solutions
  • Leverages the firm’s broad set of solutions including tax, estate planning, insurance, and more to provide a comprehensive offering to our clients
  • Ensures adherence to compliance and regulatory policies as well as company standards of client care
  • Acts as a fiduciary, placing client interests and outcomes first
  • Acts as a senior wealth advisor while leading a small team of other advisors
  • Focuses on deepening relationships with an established base of high-net-worth clients and organically growing their practice through referrals
  • Plays a key role in apprenticing and developing advisor team members to maximize client excellence and growth
What we offer
What we offer
  • Competitive benefits including health/dental/vision and 401 K
  • Additional benefits include employee assistance programs, wellness programs, parking, commuter benefits, and life insurance
  • Fulltime
Read More
Arrow Right
New

Data Analyst

We are looking for an experienced Data Analyst to join our team on a long-term c...
Location
Location
United States , Minneapolis
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proficiency in Microsoft Excel, including advanced formulas and data manipulation
  • Demonstrated experience in handling data validation and accuracy across systems
  • Familiarity with provider network operations and healthcare-related data
  • Ability to work effectively in a cross-matrixed organizational structure
  • Strong consumer-facing skills with the ability to interact professionally with clients
  • Experience in incident resolution and querying data sources
  • Knowledge of configuration management and pre/post go-live software adjustments
  • Capability to meet service level agreements and deadlines while maintaining high data quality standards
Job Responsibility
Job Responsibility
  • Resolve data-related incidents by updating records and querying various data sources
  • Apply specialist quality standards to maintain data integrity
  • Validate data accuracy across multiple systems to ensure consistency
  • Update client data based on specific requirements while adhering to service level agreements
  • Configure software applications both before and after system go-live
  • Collaborate with care organizations to gather and update data in alignment with requirements
  • Provide support in managing data updates and ensuring the availability of accurate information
  • Utilize advanced Excel formulas to standardize and compare data efficiently
  • Foster effective communication with clients and stakeholders to address data needs and changes
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan
Read More
Arrow Right