Jobs at CVS Health

Negotiate and manage contracts with healthcare providers, ensuring compliance with standards and working towards financial goals while facilitating dispute resolution and enhancing the provider network.

Lead and coach a pharmacy reimbursement appeals team to ensure timely, accurate adjudication and regulatory compliance. Manage Service Warranty and secondary appeals, partner with legal, finance, and operations to implement process improvements and automation, analyze trends, and oversee quality control to meet state regulatory requirements.

Lead and manage teams to modernize legacy applications into cloud‑native, microservices-based solutions using automation and GenAI. Own end‑to‑end modernization delivery (replatforming, refactoring, decomposition), drive DevOps/Agile practices, pipeline automation, observability/AIOps, and ensure security, compliance, performance, and cost optimization while aligning with enterprise standards and measurable KPIs.

Work with clinical and claims data to support Clinical Advisors: produce scheduled and ad hoc client reports, assist with PA criteria submission (CAS, MedHOK), communicate formulary changes, manage prior authorization updates/migrations, perform quality checks, analyze impact/remediation, propose process improvements, and contribute to special projects to improve efficiency and client satisfaction.

Lead design, build, and operation of large-scale, distributed, full-stack systems. Drive technical initiatives, deliver iterative customer-focused releases, improve maintainability and performance, mentor engineers, research and adopt new technologies, and collaborate across teams to meet enterprise needs.

Lead analytics and AI/ML product delivery for PBM member experience. Define requirements, manage backlog and Agile ceremonies, partner with data science and engineering, prioritize roadmaps, engage stakeholders, and introduce tools and methods to drive analytics-driven product outcomes and adoption.

Lead communications measurement by integrating earned media, social, and owned-channel data to produce dashboards, insights, and recommendations that optimize reputation and campaign performance. Maintain data quality, support audience and survey research, and collaborate with stakeholders to improve measurement approaches and reporting processes.

Drive revenue growth for assigned commercial health products by enabling national account sales, developing sales strategies, supporting pipeline and client/broker engagements, providing market insights, tracking KPIs, and influencing product roadmap and positioning to improve adoption and penetration.

Lead data strategy and governance for PBM domains: define use cases, validate technical execution, set data quality metrics, empower end-users, standardize processes, allocate resources, and represent domain in stewardship councils to ensure compliant, accessible, and valuable data.

Design, build, and maintain scalable automated test frameworks for web and mobile using Playwright, Selenium, and Cypress. Develop API and end-to-end tests, integrate tests into CI/CD pipelines, lead defect triage and root-cause analysis, ensure healthcare compliance (HIPAA/Medicare), and leverage agentic AI tools to accelerate test authoring and maintenance.

Lead and build the Product Execution function to translate product strategy into field-ready execution, drive product education and storytelling, support sales and adoption across territories, monitor adoption performance, and establish operating rhythms, metrics, and decision frameworks to improve territory product adoption and market readiness.

Assess clinical information and apply criteria to render coverage determinations, coordinate care with providers, identify referrals and quality opportunities, and support utilization/benefit management while working remotely in a 24/7 UM operation.

Lead analytics and dashboard development to support Zinc contract negotiators. Consolidate data requests, build centralized repositories and metrics, analyze pharmaceutical market and claims data, create documentation, and present insights to senior leadership to inform trade and contracting decisions.

Translate and clarify self-funded plan benefit information into compliant plan documents (SPDs, amendments, SBCs, restates). Analyze plan language for regulatory compliance, draft/edit documentation, meet quality standards, support onboarding and training, and contribute to process improvements and department projects.

Lead architecture and implementation of scalable myPBM Clinical systems. Design solutions, drive CI/CD, perform code reviews, mentor engineers, collaborate with product and architecture, and ensure high-quality delivery using cloud, streaming, and container technologies.

Manage APCD reporting and state regulatory compliance across multiple states. Lead projects, interpret regulations into business/system requirements, oversee submissions, investigate issues, write business requirements, analyze data, automate workflows, train staff, build cross-functional relationships, and escalate risks while producing management reports.

Greet patients and guests, manage check-ins and forms, schedule and reschedule appointments, collect co-pays, update patient records in the EMR, handle inbound/outbound calls and faxes, maintain lobby areas, and support clinic operations including occasional regional float.

The role involves leading machine learning model design, AI development, data analysis, and enhancing digital workplace experiences at CVS Health.

Supervise a small audit team to execute Sarbanes-Oxley (SOX) testing for the Health Services segment, support annual audit planning, collaborate with business partners and external auditors, evaluate and recommend improvements to financial controls and compliance processes, and participate on cross-functional projects.

The Senior Manager, Sales Operations & Analytics oversees sales processes, drives operational effectiveness, and provides performance insights to enhance sales productivity and decision-making.