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Work From Home Charleston, IL jobs

- 20 jobs
  • Customer Service Specialist (Remote)

    HB Travels

    Work from home job in Tuscola, IL

    About the Role We are seeking a Customer Service Specialist to support travelers throughout their planning and booking experience. In this role, you will assist clients with inquiries, provide accurate information, manage updates to travel arrangements, and ensure each traveler feels confident and cared for from start to finish. At HB Travels Agency USA, we are committed to providing dependable, high-quality service to clients nationwide. Key Responsibilities Respond to customer inquiries via email, phone, and messaging platforms in a timely, professional manner. Assist clients with booking questions, modifications, cancellations, and special travel requests. Provide clear, accurate information on destinations, travel documentation, and agency processes. Track and update customer details to ensure accuracy and smooth communication. Follow up before and after travel to confirm details and gather feedback. Handle client concerns with patience, empathy, and strong problem-solving skills. Benefits Fully remote flexibility - work from anywhere with a schedule that fits your lifestyle. Travel perks, discounted rates, and industry-only benefits. Training and support to help you grow in the travel and customer care field. A collaborative, motivated team environment committed to exceptional service. What We're Looking For Strong verbal and written communication skills. Experience in customer service-experience in travel, hospitality, or tourism is a plus. High attention to detail and strong organizational habits. Ability to learn new tools, software, and systems quickly. A friendly, patient, and service-oriented attitude.
    $28k-36k yearly est. 17d ago
  • Entry Level Sales - Part Time - Paid Weekly

    Vector Marketing 4.3company rating

    Work from home job in Mattoon, IL

    Vector Marketing is looking to fill part-time sales positions right away. Request an interview today and start work within the week. details? Our reps sell Cutco products through one-on-one appointments, explaining the products, and placing any orders. Previous work experience isn't required, we are just looking for people who enjoy working with others. Reps are paid $25.00 base-appt that isn't based on sales or results, but they can earn more based on commission. If they have an off week, they still get paid for the work they did, but can earn more based on performance. We help reps create a schedule that works best for them. Some work as much as possible, some part time, and others are just looking to make some extra income around their classes, other jobs, and family obligations. Semester break work schedules are available for anyone looking for temporary work. Our Cutco products are used in the kitchen and some outdoor tools as well. Previous knowledge about home goods, sales, or work experience is not needed. We are just looking for people who enjoy working with others. We've been training people to do well for over 40 years. Even if someone doesn't stay with us long term - the sales, networking, and communication skills they build are needed for every field. Reps work locally after training. Meetings and training are held in the office. What are the basic requirements? - Enjoys working with others - All ages 18 + or 17 and graduating in 2025 are encouraged to apply - Some conditions apply - Able to interview within the week - Willing to learn and apply new skills Who would do well here? People who have done well with us have had experience in all different lines of work - retail, fast food, cashier, grocery store clerk, work from home jobs, administrative assistant, receptionist, server, landscape, warehouse worker, and in just about any field you can imagine. We also welcome applicants who haven't had any work experience. If they have a positive attitude and enjoy working with people, they can do well here. If you think you would be a great fit for our sales team, fill out contact information and a receptionist will send you a text about setting up a virtual interview with a manager. We encourage applicants of all ages and experience, as we do not discriminate on the basis of an applicant's age.
    $35k-44k yearly est. 7d ago
  • Senior Underwriter - Medical Professional Liability

    Proassurance Corporation 4.8company rating

    Work from home job in Kansas, IL

    An exciting opportunity exists to join the ProAssurance family of companies! Our mission is powerful and simple: We protect others. Choosing a place to apply your talents is an important decision for anyone. You have plenty of options. Why choose ProAssurance? At ProAssurance, we sell a pledge, and that pledge is delivered by our team members. We are seeking individuals who value integrity, leadership, relationships, and enthusiasm-and want to build their career with a great company where they can be their authentic self and feel valued, recognized, and rewarded for their contributions. ProAssurance specializes in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance. We are an industry-leading specialty insurer, with job opportunities in much of the contiguous United States. This position supports our medical professional liability line of business. Position is based in the Central time zone in order to meet the needs of the business and we can accommodate a fully remote work arrangement depending upon location of the selected candidate. The primary responsibility of the Senior Standard Underwriter is to support the MPL underwriting strategy by underwriting and selecting new business that will produce an underwriting profit. This position is responsible for reviewing submissions and identifying exposure and risk and determining accurate classifications and rates and may answer questions concerning a policy status or billing for policies. Under the guidance of the Supervisor/Director, they may analyze applications and screen applicants based on certain criteria and ensure that policy transactions such as renewals or quotes are issued, and changes are recorded correctly. What you'll do: * 45% - Perform underwriting functions in accordance with established customer service standards. Create new business and review renewal business indications or quotes as requested by insured or agent. Perform underwriting duties in accordance with established guidelines. Perform duties within the framework of the rules, rates, and coverage forms filed and approved by law in the state of responsibility. Determine whether to write risk and whether any surcharges, discounts, or credits are applicable to coverage. * 10% - Interaction with agents/brokers to foster good relationships, identify prospects, and other opportunities for business development. * 10% - Work with Underwriting Techs to foster efficient and accurate service to our agents and insureds. * 5% - Review with underwriting technician risk profile and loss history information and take necessary steps to ensure that each renewal is appropriately classified and priced. Discuss issues with Claims Department as needed. * 5% - Approve underwriting transactions and bind coverage within authority; provide analysis and file documentation to support decisions. * 5% - Attend Board/Department meetings. Prepare underwriting reports and reviews as requested by management. * 5% - Request Risk Management referrals as indicated. * 5% - Some overnight travel required for meetings with agents/brokers or insureds, and to national trade shows or conferences. * 5% - Supervise the underwriting process when Management is unavailable. * 5% - Perform special projects and lead initiatives as directed by management. What we're looking for: * Bachelor's degree in risk management or insurance, or another business field. Eight years insurance experience required in lieu of degree. * Seven years medical professional liability underwriting experience. * Completion or progress towards an insurance or professional liability designation (e.g., RPLU, CPCU, AINS) desired. * Resident P&C insurance agents license may be required (can be obtained within one year from employment start date). * Demonstrated proficiency in underwriting skills through achieving targeted financial and operational results. * Demonstrated ability to work independently within underwriting authority. * Proven ability to establish effective internal and external relationships. * Ability to attend insurance and industry/business functions to promote and present a positive image of the Company. * Critical thinking/problem solving skills required. * Understanding of insurance and medical terminology, and insurance and underwriting principles required. * Proficiency with Microsoft Office Suite. * Excellent analytical, organizational, and interpersonal skills. * Effective cross-organizational team player. * Self-motivated and able to accomplish multiple tasks in a timely manner. * Accomplished written and verbal communication skills. #LI-Remote We are committed to providing a dynamic and inclusive environment where everyone can do their best work and grow personally and professionally. For that reason, we partner with The Predictive Index (PI) - an organization equally committed to improving the working lives of people, to help us hire the best talent by providing additional insight about one's work style. The position you applied to requires completion of two assessments prior to being scheduled to interview with a hiring manager. A Talent Acquisition team member may review your application and contact you before the assessment is complete. These assessments are Behavioral and Cognitive (internal candidates will only receive the Behavioral assessment), and each assessment takes less than 12 minutes to complete. After submitting your application, you will receive two emails from The Predictive Index inviting you to complete each of these assessments (please check your SPAM or Junk email folder if you do not see these emails in your inbox). Position Salary Range $74,713.00 - $123,289.00 The salary range displayed represents the entirety of the pay grade for this position. Most candidates will start in the bottom half of the range. Factors that may be used to determine your actual salary include your specific skills, how many years of experience you have, your location and comparison to other team members already in this role. Build your career with us and enjoy access to a best-in-class benefits program.
    $74.7k-123.3k yearly Auto-Apply 4d ago
  • Sales Executive

    Oscar Health Insurance 4.6company rating

    Work from home job in Kansas, IL

    Hi, we're Oscar. We're hiring a Sales Executive to join our Sales team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: As a Sales Executive, you will play a crucial role in driving membership growth for the business by identifying and qualifying potential leads. You will ensure that insurance brokers across our coverage area have the information and tools to effectively understand and sell our product. You will report into a Director, Sales. Work Location: This is a remote position based in the field, open to candidates who reside in Kansas. Your daily work will involve a blend of work from your home office and frequent travel for client meetings. Occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $69,600 - $91,350 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and sales commissions. Responsibilities: * Conduct research to identify potential leads and target accounts. * Reach out to prospects via phone calls, emails, and social media * Qualify leads by understanding their needs and determining their potential fit with our products/services. * Drive sales efforts for the business by identifying and qualifying distribution partners (insurance brokers and agencies) and/or leads. * Collaborate with the marketing team to align on lead generation strategies and campaigns. * Maintain accurate and up-to-date records of all interactions in the CRM system. * Representing our product in the market at events / conferences as needed, which may take place during evening and/or weekend hours * Continuously improve sales skills and product knowledge through training and feedback * Identify areas where we can improve tools and processes * Compliance with all applicable laws and regulations * Other duties as assigned Requirements: * 3+ years of healthcare industry experience in a sales role or sales organization * 2+ years of experience presenting and communicating with stakeholders at all levels * Must be a licensed insurance professional or obtain within the first 90 days Bonus points: * Bachelor's Degree or 4 years of relevant experience * Proficient in Salesforce Travel Required: * Up to 50% This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.
    $69.6k-91.4k yearly Auto-Apply 17d ago
  • Enterprise Principal Architect (Remote - in Market)

    Rural King 4.0company rating

    Work from home job in Mattoon, IL

    About us Rural King is America's Farm and Home Store, providing essentials to the communities we serve. With a wide array of necessities ranging from food and feed to farm and home products, Rural King serves over 150 locations across 17 states and is constantly expanding. Our annual sales exceed $2.5 Billion, and our heart beats in Mattoon, IL, home to our corporate office, distribution center, and flagship store. One thing our customers appreciate is our unique shopping experience, complete with complimentary popcorn and coffee. It's just one way we show our appreciation for their support. At Rural King, we value our associates and strive to create a positive, rewarding workplace. We offer growth opportunities, competitive benefits, and a people-first environment where dedicated individuals come together to serve rural communities passionately. Join us, and you'll find not just a job but a chance to grow professionally, contribute meaningfully, and make a difference in the lives of those we serve. How we reward you 401(k) plan that provides a 100% match on the first 3% of your contributions and 50% of the next 2% Healthcare plans to support your needs Virtual doctor visits Access to Centers of Excellence with Barnes Jewish Hospital and Mayo Clinic's Complex Care Program 15% Associate Discount Dave Ramsey's SmartDollar Program Associate Assistance Program RK Cares Associate Hardship Program 24/7 Chaplaincy Services Company paid YMCA Family Membership What You'll Do The Principal Enterprise Architect, with a specialized focus on Oracle technologies, is a strategic leader responsible for the overall design and evolution of our enterprise-wide technology architecture. This role will drive the strategy, roadmap, and governance for all IT initiatives, including core database systems, applications (e.g., Oracle, HCL Commerce, Infios WMS, etc), and cloud services (OCI). The ideal candidate will bridge the gap between business objectives and technical implementation, ensuring our IT investments are scalable, secure, and aligned with long-term organizational goals. * Lead the development of enterprise architecture strategies and roadmaps for IT platforms, encompassing applications, data, and infrastructure * Act as the primary technical authority for IT solutions, providing expert guidance on complex architectural decisions and best practices for on-premise and cloud environments * Design and oversee the implementation of large-scale, complex IT solutions, including migrations, upgrades, and integrations with other enterprise systems * Partner with business and technology stakeholders to translate business requirements into robust and scalable architectural designs * Establish and enforce architectural standards, policies, and governance models for all IT projects to ensure consistency, security, and cost-effectiveness * Provide technical leadership and mentorship to solution architects, developers, and engineers, fostering a culture of technical excellence * Monitor emerging technologies and industry trends to assess their potential impact and value to the organization * Deliver clear, audience-appropriate updates to executives and cross-functional teams * Use discretion and independent judgment in daily decisions while maintaining high confidentiality and professionalism * Actively participate in learning initiatives such as training programs, workshops, and webinars. Leverage these opportunities to acquire new knowledge, refine existing skills, and stay current on the latest developments * Provide friendly, proactive, and professional internal and external support to others, assisting with inquiries, concerns, and issues promptly and effectively * Demonstrate behaviors that exemplify Rural King's Values: People First, Integrity, Attitude, Initiative, Teamwork, Accountability, and Continuous Improvement * Perform other duties as assigned Supervisory Responsibilities Yes Essential Qualities for Success * 10+ years of progressive experience in IT roles, with significant time spent in an enterprise or solutions architecture capacity, plus 2+ years leading or supervising teams * Bachelor's degree in a relevant field (or equivalent experience) * Deep, hands-on expertise with Oracle database technologies (e.g., RAC, Exadata, Oracle Autonomous Database, GoldenGate) * Significant experience with Oracle Cloud Infrastructure (OCI), including design, deployment, and migration strategies * Significant experience with Orace Integration Cloud (OIC) in creating automation workflows, configuring adaptors, and designing / building API integrations * Expertise in Oracle enterprise applications like E-Business Suite (EBS), Fusion Applications, and Oracle Retail Suite * Strong understanding of integration strategies and middleware, including SOA, microservices, and APIs * Experience with other public cloud platforms (e.g., AWS, Azure) is a plus * Experience with eCommerce platforms (ie HCL Commerce) is a plus * Expereince with Infios WMS (ie Highjump) is a plus * Proficiency with Microsoft Office Suite or related software * Exceptional communication and presentation skills, with the ability to articulate complex technical concepts to executive-level stakeholders * Strong analytical, problem-solving, and decision-making capabilities * Proven leadership and collaboration skills, with experience leading cross-functional teams * Ability to manage multiple priorities in a dynamic, fast-paced environment * Working knowledge of Microsoft Office Suite. * Comfortable navigating computer systems and software to assist customers or manage activities Physical Requirements * Ability to maintain a seated or standing position for extended durations. * Prolonged periods working at a computer. * Occasional travel to stores/DCs as needed for deployments, audits, or incidents. * Capability to lift 15 pounds periodically. * Ability to navigate and access all facilities. * Close vision for computer-related activities. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions. The pay range for this position is $135,000 - $170,000 annualized and is bonus eligible. Exact compensation is determined by factors such as relevant geographic location, education, certifications, experience, job level, shift, and organizational needs. To learn more about our benefits, review here ************************************************************************************ Responsibilities What You'll Do The Principal Enterprise Architect, with a specialized focus on Oracle technologies, is a strategic leader responsible for the overall design and evolution of our enterprise-wide technology architecture. This role will drive the strategy, roadmap, and governance for all IT initiatives, including core database systems, applications (e.g., Oracle, HCL Commerce, Infios WMS, etc), and cloud services (OCI). The ideal candidate will bridge the gap between business objectives and technical implementation, ensuring our IT investments are scalable, secure, and aligned with long-term organizational goals. - Lead the development of enterprise architecture strategies and roadmaps for IT platforms, encompassing applications, data, and infrastructure - Act as the primary technical authority for IT solutions, providing expert guidance on complex architectural decisions and best practices for on-premise and cloud environments - Design and oversee the implementation of large-scale, complex IT solutions, including migrations, upgrades, and integrations with other enterprise systems - Partner with business and technology stakeholders to translate business requirements into robust and scalable architectural designs - Establish and enforce architectural standards, policies, and governance models for all IT projects to ensure consistency, security, and cost-effectiveness - Provide technical leadership and mentorship to solution architects, developers, and engineers, fostering a culture of technical excellence - Monitor emerging technologies and industry trends to assess their potential impact and value to the organization - Deliver clear, audience-appropriate updates to executives and cross-functional teams - Use discretion and independent judgment in daily decisions while maintaining high confidentiality and professionalism - Actively participate in learning initiatives such as training programs, workshops, and webinars. Leverage these opportunities to acquire new knowledge, refine existing skills, and stay current on the latest developments - Provide friendly, proactive, and professional internal and external support to others, assisting with inquiries, concerns, and issues promptly and effectively - Demonstrate behaviors that exemplify Rural King's Values: People First, Integrity, Attitude, Initiative, Teamwork, Accountability, and Continuous Improvement - Perform other duties as assigned Supervisory Responsibilities Yes
    $135k-170k yearly Auto-Apply 34d ago
  • Work from Home Inbound Customer Service (State of Kansas)

    Colony Brands, Inc. 4.4company rating

    Work from home job in Kansas, IL

    SC Data Center, Inc. participates in the Department of Homeland Security U.S. Citizenship and Immigration Services' E-Verify program * This position is only open to candidates 18 years or older living in Alabama, Arkansas, Georgia, Iowa, Kansas, Louisiana, Mississippi, Missouri, North Carolina, or Wisconsin.* Work at Home! You can apply online at ***************************************************** Please call us at ************ if you have additional questions! Join our team! Are you looking for a flexible part-time, seasonal job that fits your schedule? Start at $14.00 per hour and earn upsell commission on top! Choose your own availability and work around your existing commitments, making this the perfect role for those looking to earn extra cash before the holidays or as a seasonal second job. Join a supportive team that values your time and effort. As a Work at Home Inbound Customer Service Representative you are responsible for maintaining positive customer relations by addressing all types of product related concerns, including: taking orders, verifying information, tracking packages, and answering customer questions. Working from home entails a high level of computer knowledge as you will be required to navigate through multiple systems and enter information using your keyboard including function keys while speaking with customers on the phone. SC Data Center Inc., offers flexible schedules, paid training, employee discounts up to 50%, and Booster Discount Certificates that allow employees to purchase company products for free. As a Home Agent you will be able to work from the ease of your own home provided that your computer meets our minimum technical requirements (see below). Your next opportunity is just a few clicks away! Preferred Computer Requirements A PC or Laptop with: * Current and supported MS Windows 11 Operating System (No Mac, Vista, Chromebook, or XP) * Processor * AMD Ryzen 2nd Generation or newer OR * INTEL i-series 8th Generation or newer with 4 or more cores and must be 2018 or newer * 8GB RAM or installed memory * 10GB of Free Hard Disk Space Dedicated High Speed Internet: * Internet Download Speed: 10.0 MBPS * Internet Upload Speed: 5.0 MBPS * Wired Internet with a cable connection (Dial-up, Wi-Fi, Hotspots, and Satellite are not allowed) Minimum Computer Requirements A PC or Laptop with: * Current and supported MS Windows 11 Operating System (No Mac, Vista, Chromebook, or XP) * Processor * AMD 2.1GHZ or higher OR * INTEL 1.8GHZ or higher, OR * INTEL 1.7GHZ or lower; must be i3, i5, i7, or Pentium with 4 or more cores and be 2016 or newer * 4GB RAM or installed memory * 10GB of Free Hard Disk Space Dedicated High Speed Internet: * Internet Download Speed: 4.0 MBPS * Internet Upload Speed: 2.0 MBPS * Wired Internet with a cable connection (Dial-up, Wi-Fi, Hotspots, and Satellite are not allowed) Other Requirements * Keyboard: Function Keys (F-Keys) * Wired USB Headset * Webcams are recommended (not required) * Dual monitors recommended (not required) * Minimum monitor size of 17+ inches recommended (not required) * External mouse recommended (not required) Training Requirements (Mandatory): * 1st Shift Training - 2 weeks (M-F), 8:30am-3:30pm CST * 2nd Shift Training - 2 weeks (M-F), 5:00pm-11:00pm CST * Weekend Training - 3 weekends (Sa-Su), 8:00am-4:00pm CST Most communication throughout the hiring process will be conducted via email. Please ensure you enter a valid email address that you check regularly when completing the application. You can expect emails from **************************** and **************************. To prevent these emails from ending up in your junk/spam folders, we ask that you set your email filter to unblock, whitelist, or accept emails from these addresses. Benefits Details Temporary/Part-Time Employee Benefits/Perks: Performance Based Pay/Incentives - We provide job performance pay and incentive based pay for the majority of our Temporary/Part-Time roles Shift Premium pay for 2nd, 3rd, and Weekend shifts Holiday Pay for employees returning for their fifth consecutive season Safety and Attendance Incentives Employee Discounts - Our employee sales program offers employee discounts on items ordered from our catalogs and selected Outlet Store. Discounts range from 45% to 50% off.Employee Mini Stores - Discounted product offered at our multiple Employee Only StoresFlexible Work Schedules
    $14 hourly Easy Apply 60d+ ago
  • Medical Director - Commercial

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryAetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. This is a remote based (work from home) role and can be based anywhere in the US. In the Medical Director role you will collaboratively implement medical policy. You'll participate in the development, implementation, and evaluation of clinical/medical programs and promote Aetna's medical management programs and the Employer's (Plan Sponsor's) resources to address member needs across the continuum of care. You will support the Medical Management staff ensuring timely and consistent responses to members and providers, and the dedicated Account Team & Employer. In addition, you will oversee utilization review/quality assurance, and provide clinical guidance to support case management activity. In this role you'll provide clinical expertise and business direction in support of medical management programs through participation in clinical team activities. You will also act as a lead business and clinical liaison to account teams and health care providers to support the effective execution of medical services programs by the clinical teams. Required Qualifications *2 or more years of experience in Health Care Delivery System e. g. , Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances*M. D. or D. O. , Board Certification in a recognized specialty including post-graduate direct patient care experience. Preferred Qualifications*Health plan/payor experience. *Managed Care experience*Electronic medical systems/record experience Education*M. D. or D. O. , Board Certification in a recognized specialty including post-graduate direct patient care experience. Pay RangeThe typical pay range for this role is:$174,070. 00 - $374,920. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/30/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $174.1k-374.9k yearly 23d ago
  • M&A Research Analyst

    Harris Computer Systems 4.4company rating

    Work from home job in Kansas, IL

    At Harris we are disciplined deployers of capital and great operators of vertical market software businesses. Our companies provide mission-critical software solutions to multiple vertical markets across the globe. We are an operating group of Constellation Software Inc. (TSX: CSU), one of the world's most active acquirers of software businesses and home to a portfolio of over 500 companies in 150 countries. As a Research Analyst you will have a critical role in supporting our M&A process. You will be successful in this role if you have a passion for research, analysis, investments, data, software, and you love to continuously learn. We are looking for someone who wants to grow their career for the long term in this role as you will become a vital component of our current and future investment strategy. WHAT WILL YOU BE DOING Majority (>80%) * Qualifying M&A Prospects - Understand and use our investment criteria for rigorous screening of prospects * Big Data - Manage, monitor and maintain the data quality of our watch-list of M&A prospects in our CRM with reports and dashboards * Research - Perform primary research on owner-operated businesses, private equity portfolio companies, as well as potential carve outs of multinational corporations * Research - market-sizing, industry trends, and competitor analysis * Research - Software M&A advisors, brokers, and investment banks * Data sources - Identify & analyze relevant 3rd party data sources such as industry tradeshows and conferences for M&A prospects * Analysis-Prepare and report on various statistics and KPIs related to our M&A pipeline Minority ( * Ad Hoc Analysis & Special Projects with our senior M&A and Corporate Development leaders to support capital deployment WHAT WE ARE LOOKING FOR * 2-4+ years of experience in finance, accounting, software, or data analysis * Bachelor's degree in Business, Finance, Accounting, or Economics (BBA/ BCom etc.) * Self-motivated individual with an ability to perform independently in a fast-paced environment * Excellent attention to detail, and the ability to manage multiple priorities and meet tight deadlines * Excellent organizational skills, written and verbal communication skills, and analytical ability * Proficient in Microsoft Office, particularly Excel and PowerPoint * Leverages AI for research and analysis * High degree of professionalism and integrity * Ability to work remotely in the U.S. or Canada
    $54k-79k yearly est. Auto-Apply 38d ago
  • Case Manager Registered Nurse (Remote)

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryCVS Health Aetna has an opportunity for a full-time Case Manager, Registered Nurse (RN). Case Managers serve as dedicated advocates for members who are unable to advocate for themselves. In this role, you will assess, plan, implement, and coordinate comprehensive case management activities. Your focus will be to evaluate members' medical needs and facilitate services that support their overall health and well-being. Schedule: Monday-Friday, 8:00 AM-5:00 PM ESTNo nights, weekends, or holidays required. Key Responsibilities of the Case Manager RN (Includes but is not limited to) Conduct comprehensive assessments of members' physical, emotional, and social needs. Develop and implement individualized care plans based on clinical findings and member goals. Coordinate services across healthcare providers, specialists, and community resources. Monitor and evaluate care plans regularly, adjusting as needed to improve outcomes. Advocate for timely and appropriate healthcare services to support member well-being. Document case activities, interventions, and communications accurately and in compliance with regulatory requirements. Collaborate with interdisciplinary teams to ensure continuity of care. Participate in team meetings, training sessions, and quality improvement initiatives. Travel locally for in-person case management activities, as directed by leadership or business needs. Required QualificationsMust be a Registered Nurse with an active state license in good standing, valid in the region where duties are performed. Compact RN License or license in multiple states or willing to obtain within 3-6 months. Bilingual proficiency in Spanish. 3-5 years of clinical practice experience. 2-3 years of experience in case management, discharge planning, or home health care coordination. Comfortable working remotely and independently using collaboration tools and virtual communication platforms. Willingness and ability to travel within a designated geographic area for in-person case management activities as needed. Preferred QualificationsStrong analytical and problem-solving skills. Excellent communication, organizational, and interpersonal skills. Self-motivated and able to work independently. Proficient in navigating multiple systems and applications; skilled in typing and keyboard use. Familiarity with corporate software tools such as Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications. EducationAssociate's Degree in Nursing. BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $155,538. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/09/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $54.1k-155.5k yearly 7d ago
  • Lead Delivery Engineer (Remote)

    Broadridge 4.6company rating

    Work from home job in Kansas, IL

    At Broadridge, we've built a culture where the highest goal is to empower others to accomplish more. If you're passionate about developing your career, while helping others along the way, come join the Broadridge team. We're hiring a Lead Delivery Engineer to manage complex, multi-workstream client implementations from discovery through launch and stabilization. In this role, you will translate enterprise requirements into scalable solutions and integrations, drive program governance and stakeholder alignment, and serve as a senior delivery liaison to Product and Engineering. Responsibilities: * Lead complex, multi‑workstream client implementations from discovery through production launch and stabilization, meeting scope, timeline, quality, and budget goals. * Translate enterprise requirements into scalable configurations and integration designs (APIs, SSO, data feeds), ensuring performance, observability, security, and compliance. * Establish and run program governance: plans, milestones, KPIs, change control, executive status reporting; managing stakeholder alignment and expectations. * Serve as a senior delivery liaison to Product and Engineering: shape backlog priorities, write clear tickets and acceptance criteria, drive sprint commitments, validate outcomes. * Own risk management and escalation paths; anticipate dependencies, remove blockers, and resolve cross‑functional issues rapidly; provide weekly status and escalate risks. * Lead client demos, solution walkthroughs, UAT planning/execution, training, and handoffs to Support and Customer Success with complete runbooks and documentation. * Optimize implementation and rollout processes; champion automation, templates, and tooling; lead scoping and subsequent pricing for engagements. Qualifications: * 5+ years of experience in delivery engineering, implementation, or technical program management in a SaaS or enterprise software environment, including leading complex client programs. * Proven track record managing multiple concurrent implementations and cross‑functional teams in an agile setting (up to 3 engagements simultaneously). * Undergraduate degree or equivalent combination of training and experience. * Hands‑on experience configuring web/SaaS products and orchestrating integrations and custom implementations; ability to document business rules and ensure proper configuration. * Strong client‑facing communication, negotiation, and executive‑level status reporting skills; ability to convey complex information between business and technical stakeholders. * Exceptional organization, analytical, and problem‑solving skills; ability to operate in fast‑paced, high‑pressure environments and make data‑driven decisions. Preferred qualifications: * Deep familiarity with agile practices (epics, stories, acceptance criteria), sprint planning, backlog management, and day‑to‑day project delivery. * Enterprise integration and data expertise: API design/consumption, SSO, data mapping/ETL; formats such as JSON/XML; data validation and troubleshooting. * Exposure to CI/CD, release management, and observability for production readiness and post‑launch monitoring. * Experience leading UAT, training, change management, and promoting education services to drive onboarding and readiness. * Practical knowledge of SEO, data modeling, and integration best practices to improve ROI throughout engagements. * Experience partnering with internal stakeholders; contributing to process improvements, automation opportunities, and execution playbooks; assisting with internal training. Compensation Range: The salary range for this position is between $85.000.00-$95,000.00. Broadridge considers various factors when evaluating a candidate's final salary including, but not limited to, relevant experience, skills, and education. Bonus Eligibility: Bonus Eligible Benefits Information: Please visit ************************** for information on our comprehensive benefit offerings for this role. All Colorado employees receive paid sick leave in compliance with the Colorado Healthy Families and Workplaces Act and other legally required benefits, as applicable. Apply by clicking the application link and submitting your information. The deadline to apply for this role is February 15th, 2026. #LI-DS1 #LI-Hybrid We are dedicated to fostering a collaborative, engaging, and inclusive environment and are committed to providing a workplace that empowers associates to be authentic and bring their best to work. We believe that associates do their best when they feel safe, understood, and valued, and we work diligently and collaboratively to ensure Broadridge is a company-and ultimately a community-that recognizes and celebrates everyone's unique perspective. Use of AI in Hiring As part of the recruiting process, Broadridge may use technology, including artificial intelligence (AI)-based tools, to help review and evaluate applications. These tools are used only to support our recruiters and hiring managers, and all employment decisions include human review to ensure fairness, accuracy, and compliance with applicable laws. Please note that honesty and transparency are critical to our hiring process. Any attempt to falsify, misrepresent, or disguise information in an application, resume, assessment, or interview will result in disqualification from consideration. US applicants: Click here to view the EEOC "Know Your Rights" poster. Disability Assistance We recognize that ensuring our long-term success means creating an environment where everyone is welcome, where everyone's strengths are valued, and where everyone can perform at their best. Broadridge provides equal employment opportunities to all associates and applicants for employment without regard to race, color, religion, sex (including sexual orientation, gender identity or expression, and pregnancy), marital status, national origin, ethnic origin, age, disability, genetic information, military or veteran status, and other protected characteristics protected by applicable federal, state, or local laws. If you need assistance or would like to request reasonable accommodations during the application and/or hiring process, please contact us at ************ or by sending an email to ************************.
    $92k-119k yearly est. Auto-Apply 60d+ ago
  • (Remote) Systems Analyst

    Harris Computer Systems 4.4company rating

    Work from home job in Kansas, IL

    A division of Harris; Mid-America Computer Corporation (MACC) is seeking a skilled Software Engineer with expertise in MSSQL, REST API, C# (.NET Core). The ideal candidate will be responsible for designing, developing, and maintaining high-quality software solutions that meet our business needs. Who We Are: MACC is a billing solutions company providing customer management and financial software, plus a variety of data processing, statement printing, and fulfillment services for communications companies that offer voice, video, wireless, data services and utility services. MACC is a member of the Harris Computer family of companies. This remote role welcomes candidates anywhere in Canada and the US. Salary: 50K - 65K What You'll Do: * Design, develop, and maintain database solutions using MSSQL. * Develop and maintain RESTful APIs to support various applications. * Write clean, scalable, and efficient code in C# using .NET Core. * Develop and maintain front-end applications using Angular, Typescript, HTML, and CSS. • Partner with cross-functional teams to define, design, and ship new features. * Troubleshoot and debug applications to optimize performance. * Take part in code reviews and contribute to the continuous improvement of the development process. * Stay up to date with the latest industry trends and technologies. What We're Looking For: * Associates degree in Computer Science, Engineering, or a related field. * Proven experience as a Software Engineer or similar role. * Proven proficiency in MSSQL and database design. * Experience with REST API development and integration. * Proficiency in C# and .NET Core framework. * Exceptional problem-solving skills and attention to detail. * Excellent communication and teamwork skills. * Ability to work autonomously and manage multiple tasks. Preferred Qualifications: * Experience with cloud platforms such as Azure or AWS. * Knowledge of Agile development methodologies. * Familiarity with GitHub practices and tools. Required Skills and Qualifications: * Associates degree in Computer Science, Engineering, or a related field. * Proven experience as a Software Engineer or similar role. * Strong proficiency in MSSQL and database design. * Experience with REST API development and integration. * Proficiency in C# and .NET Core framework. * Strong problem-solving skills and attention to detail. * Excellent communication and teamwork skills. * Ability to work independently and manage multiple tasks effectively. What we can offer: * 3 weeks' vacation and 5 personal days * Comprehensive Medical, Dental, and Vision benefits starting from your first day of employment * Employee stock ownership and RRSP/401k matching programs * Lifestyle rewards * Remote work and more! About Harris: Harris is a leading provider of mission critical software to the public sector in North America. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals. Our success has been realized through investments in our proprietary software and market expertise. This focus, combined with acquiring businesses that build upon or complement our offerings, has helped drive our success. Harris will continue to growth through reinvestment - both in the people and products that we offer and making investments in acquiring new businesses. #LI-remote
    $61k-80k yearly est. Auto-Apply 4d ago
  • Utilization Management Nurse Consultant

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Regular business hours are 8:00 am-8:00 pm EST. Must be available to work any 8 hour shift within this timeframe with start times ranging from 8:00 am-11:30am EST. About Us American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. Position SummaryJoin our Utilization Management team as a Nurse Consultant, where you'll apply clinical judgment and evidence-based criteria to review inpatient and outpatient services. You'll collaborate with providers, authorize care, and escalate cases when needed, all while navigating multiple systems and maintaining accurate documentation. This role suits nurses who thrive in fast-paced environments, are highly organized, and comfortable with computer-based work. Key ResponsibilitiesApply critical thinking and evidence-based clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review. Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information. Use established guidelines to authorize services or escalate to Medical Directors as needed. Navigate multiple computer systems efficiently while maintaining accurate documentation. Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills. Perform sedentary work that primarily involves extended periods of sitting, as well as frequent talking, listening, and use of a computer. Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed, ensuring continuity of care and operational support. Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements. Remote Work ExpectationsThis is a 100% remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required QualificationsActive unrestricted state Registered Nurse licensure in state of residence required. Minimum 5 years of relevant experience in Nursing. At least 1 year of Utilization Management experience in concurrent review or prior authorization. Strong decision-making skills and clinical judgment in independent scenarios. Proficient with phone systems, clinical documentation tools, and navigating multiple digital platforms. Commitment to attend a mandatory 3-week training (Monday-Friday, 8:30am-5:00pm EST) with 100% participation. Preferred Qualifications1+ year of experience in a managed care organization (MCO). Experience in a high-volume clinical call center or prior remote work environment. EducationAssociate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$29. 10 - $62. 32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $29 hourly 3d ago
  • Chronic Care Manager (Remote - Compact States)

    Harris Computer Systems 4.4company rating

    Work from home job in Kansas, IL

    Please note that this job posting is for an evergreen position and does not represent an active or current vacancy within our organization. We continuously accept applications for this role to build a talent pool for future opportunities. While there may not be an immediate opening, we encourage qualified candidates to submit their resumes for consideration when a suitable position becomes available. Chronic Care Manager Location: Remote Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live-changing problems before they happen for patients with two or more chronic conditions. We believe every patient with chronic disease deserves consistent check-ins, follow-up, and support. The position of the Nurse Chronic Care Coordinator, Remote will perform telephonic encounters with patients on behalf of our partners each month and develops detailed care plans within our care plan templates in the electronic health record. This begins as an Independent 1099 Contractor position but offers the potential to reach full-time W2 employment (with employee benefits). Harris CCM is seeking Nurses to work part-time from their home office while complying with HIPAA privacy laws. You will set your own hours and will not be held to a daily work hour schedule. You will be contracted to work a minimum of 20hrs/wk. Harris CCM wants its team members to have the flexibility to balance their work-life with their home life. Part-time team members will typically need to dedicate an average of 20-30 hours per week to care for their assigned patients. This unique business model allows you to choose what days and what hours of the day you dedicate to care for your patients. The Care Coordinator will be assigned a patient panel based on skill and efficiency level and is expected to carry a patient panel of a minimum of 100 patients per calendar month. Care Coordinators will be expected to complete encounters on 90 percent of the patients they are assigned. Harris CCM utilizes a productivity-based pay structure and pays $10.00 per completed patient encounter up to 99 encounters/month, $10.25/encounter from 100-149 encounters/month, $12/encounter from 150-199 encounters/month, $14/encounter from 200-249 encounters/month, and $16/encounter for >250 encounters/month. Payment tier increases require 3 months consistency to achieve. A patient encounter will take a minimum of 20 minutes (time is cumulative). What your impact will be: * The role of the Care Coordinator is to abide by the plan of care and orders of the practice. * Ability to provide prevention and intervention for multiple disease conditions through motivational coaching. * Develops a positive interaction with patients on behalf of our practices. * Improve revenue by creating billable CCM episodes, increasing visits for management of chronic conditions. * Develops detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes. * Understand health care goals associated with chronic disease management provided by the practice. * Attend regularly scheduled meetings (i.e., Bi-Monthly Staff Meetings, monthly one on one's, etc.). These "mandatory" meetings will be important to define the current scope of work. What we are looking for: * Graduate from an accredited School of Nursing. (LPN, LVN, RN, BSN, etc.) * Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no disciplinary actions noted * A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home health care. * Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (MIcrosoft Office 365, Teams, Excel, etc), also while being in a HIPAA compliant area in home to conduct Chronic Care Management duties. * Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills. * Skilled in using various computer programs (If you don't love computers, you won't love this position!) * High Speed Internet and Desktop or Laptop computer (Has to be operation system of Windows or Mac) NO Chromebooks * Excellent verbal, written and listening skills are a must. What will make you stand out: * Quickly recognize condition-related warning signs. * Organized, thorough documentation skills. * Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills. * Clear diction. Applies exemplary phone etiquette to every call. * Committed to excellence in patient care and customer service. What we offer: * Contract position with opportunity to become a full-time position, to include benefit options (Medical, Dental, Vision, 401K, Life). * Streamline designed technology for your Chronic Care operations * Established and secure company since 1976, providing critical software solutions for many verticals in countries ranging from North America, Europe, Asia, and Australia. * Core Values that unite and guide us * Autonomous and Flexible Work Environments * Opportunities to learn and grow * Community Involvement and Social Responsibility About us: For over 20 years GEMMS has been the leader in Cardiology Specific EHR technology. The product was developed in a "living laboratory" of a large Cardiology Enterprise with over 40 physicians in 28 locations. For single physician offices to large cardiovascular centers that include a diagnostic centers, ambulatory surgical center, and peripheral vascular offerings. When physicians and Administrators evaluate GEMMS ONE, they are often impressed with the vast clinical cardiovascular knowledge content and operational aspects found in GEMMS ONE. GEMMS ONE EHR provides a rich array of functionality spanning the entire cycle of patient care. With everything from a patient portal to e-prescribing to clinical documentation to practice management including cardiovascular specific quality measurements and MIPS patient dashboard. GEMMS ONE EHR System provides all the medical records software tools needed to complete your daily tasks in the most efficient way possible. GEMMS ONE is a fully interoperable and integrated application that allows "real time" merging of clinical processes and revenue cycle management. It also can seamlessly connect to external revenue cycle management programs that might be used in larger enterprises so that you can get the efficiency of Cardiovascular Clinical workflow while supporting the revenue cycle requirements of larger enterprises. Complying with governmental regulations and payer requirements will be simplified, while enhancing your operational and financial performance.
    $10 hourly Auto-Apply 51d ago
  • Senior Claim Benefit Specialist - Remote

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryReviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject matter expert by providing training, coaching, or responding to complex issues. May handle customer service inquiries and problems. Additional Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, determines coverage, completes eligibility verification, identifies discrepancies, and applies all cost containment. measures to assist in the claim adjudication process. - Handles phone and written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals. - Insures all compliance requirements are satisfied and all payments are made against company practices and procedures. - Identifies and reports possible claim overpayments, underpayments and any other irregularities. - Performs claim rework calculations. - Distributes work assignment daily to junior staff. - Trains and mentors claim benefit specialists. - Makes outbound calls to obtain required information for claim or reconsideration. Required Qualifications- 18+ months of medical claim processing experience. - Experience in a production environment. - Demonstrated ability to handle multiple assignments competently, accurately and efficiently. Preferred Qualifications- Self-Funding experience- DG system knowledge Education- High School Diploma required- Preferred Associates degree or equivalent work experience. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$18. 50 - $42. 35This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $18 hourly 5d ago
  • Sales Account Executive - New Business

    Harris Computer Systems 4.4company rating

    Work from home job in Kansas, IL

    Overview of the role: We are seeking a proven sales hunter with experience selling ambulatory healthcare SaaS solutions, specifically EHR/EMR and Practice Management (PM) systems. The ideal candidate has a successful track record of closing new business, experience working with medical billing resellers and RCM companies, and an established rolodex of industry contacts that can be leveraged to quickly generate pipeline. Responsibilities: * Drive new business development within the ambulatory EMR/PM solutions market, consistently achieving or exceeding quota. * Leverage an existing network of ambulatory practices, billing companies, and reseller relationships to accelerate sales opportunities. * Build and maintain strong relationships with medical billing resellers, RCM companies, and channel partners to extend reach and market penetration. * Manage the full sales cycle: prospecting, discovery, solution demos, proposal development, negotiation, and closing. * Apply deep knowledge of ambulatory practice operations, revenue cycle workflows, and EMR/PM adoption challenges to deliver a consultative, value-driven sales approach. * Support reseller partners with joint sales calls, enablement, and go-to-market collaboration. * Partner with marketing, product, and customer success teams to align on strategy, enablement, and customer feedback. * Provide market and partner insights to influence product roadmap and reseller program improvements. * Maintain accurate forecasting, pipeline development, and CRM reporting. * Represent the company at industry events, ambulatory-focused trade shows, and reseller conferences. Requirements: * 5+ years of SaaS sales success, with at least 3+ years selling into the ambulatory healthcare market. * Proven hunter with a track record of net-new logo acquisition and consistent quota attainment. * Demonstrated success selling EHR/EMR and Practice Management (PM) solutions. * Established rolodex of ambulatory healthcare and reseller/RCM contacts. * Direct experience working with or through medical billing resellers, RCM companies, or channel partners. * Strong knowledge of ambulatory practice workflows, revenue cycle processes, and healthcare technology adoption challenges. * Excellent communication, presentation, and negotiation skills. * Ability to manage complex sales cycles with multiple stakeholders and decision-makers. * Bachelor's degree in Business, Healthcare Administration, or a related field preferred; equivalent relevant experience in healthcare technology sales will also be considered. What We Offer: * 3 weeks' vacation and 5 personal days * Comprehensive medical, dental, and vision benefits starting from your first day * Employee stock ownership and RRSP/401k matching programs * Lifestyle rewards * Remote work and more About Us: Harris is a leading provider of mission critical software to the public sector in North America. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals. Our success has been realized through investments in our proprietary software and market expertise. This focus, combined with acquiring businesses that build upon or complement our offerings, has helped drive our success. Harris will continue to growth through reinvestment - both in the people and products that we offer and making investments in acquiring new businesses.
    $70k-99k yearly est. Auto-Apply 60d+ ago
  • Enterprise Principal Architect (Remote - in Market)

    Rural King 4.0company rating

    Work from home job in Mattoon, IL

    About us Rural King is America's Farm and Home Store, providing essentials to the communities we serve. With a wide array of necessities ranging from food and feed to farm and home products, Rural King serves over 150 locations across 17 states and is constantly expanding. Our annual sales exceed $2.5 Billion, and our heart beats in Mattoon, IL, home to our corporate office, distribution center, and flagship store. One thing our customers appreciate is our unique shopping experience, complete with complimentary popcorn and coffee. It's just one way we show our appreciation for their support. At Rural King, we value our associates and strive to create a positive, rewarding workplace. We offer growth opportunities, competitive benefits, and a people-first environment where dedicated individuals come together to serve rural communities passionately. Join us, and you'll find not just a job but a chance to grow professionally, contribute meaningfully, and make a difference in the lives of those we serve. How we reward you 401(k) plan that provides a 100% match on the first 3% of your contributions and 50% of the next 2% Healthcare plans to support your needs Virtual doctor visits Access to Centers of Excellence with Barnes Jewish Hospital and Mayo Clinic's Complex Care Program 15% Associate Discount Dave Ramsey's SmartDollar Program Associate Assistance Program RK Cares Associate Hardship Program 24/7 Chaplaincy Services Company paid YMCA Family Membership What You'll Do The Principal Enterprise Architect, with a specialized focus on Oracle technologies, is a strategic leader responsible for the overall design and evolution of our enterprise-wide technology architecture. This role will drive the strategy, roadmap, and governance for all IT initiatives, including core database systems, applications (e.g., Oracle, HCL Commerce, Infios WMS, etc), and cloud services (OCI). The ideal candidate will bridge the gap between business objectives and technical implementation, ensuring our IT investments are scalable, secure, and aligned with long-term organizational goals. Lead the development of enterprise architecture strategies and roadmaps for IT platforms, encompassing applications, data, and infrastructure Act as the primary technical authority for IT solutions, providing expert guidance on complex architectural decisions and best practices for on-premise and cloud environments Design and oversee the implementation of large-scale, complex IT solutions, including migrations, upgrades, and integrations with other enterprise systems Partner with business and technology stakeholders to translate business requirements into robust and scalable architectural designs Establish and enforce architectural standards, policies, and governance models for all IT projects to ensure consistency, security, and cost-effectiveness Provide technical leadership and mentorship to solution architects, developers, and engineers, fostering a culture of technical excellence Monitor emerging technologies and industry trends to assess their potential impact and value to the organization Deliver clear, audience-appropriate updates to executives and cross-functional teams Use discretion and independent judgment in daily decisions while maintaining high confidentiality and professionalism Actively participate in learning initiatives such as training programs, workshops, and webinars. Leverage these opportunities to acquire new knowledge, refine existing skills, and stay current on the latest developments Provide friendly, proactive, and professional internal and external support to others, assisting with inquiries, concerns, and issues promptly and effectively Demonstrate behaviors that exemplify Rural King's Values: People First, Integrity, Attitude, Initiative, Teamwork, Accountability, and Continuous Improvement Perform other duties as assigned Supervisory Responsibilities Yes Essential Qualities for Success 10+ years of progressive experience in IT roles, with significant time spent in an enterprise or solutions architecture capacity, plus 2+ years leading or supervising teams Bachelor's degree in a relevant field (or equivalent experience) Deep, hands-on expertise with Oracle database technologies (e.g., RAC, Exadata, Oracle Autonomous Database, GoldenGate) Significant experience with Oracle Cloud Infrastructure (OCI), including design, deployment, and migration strategies Significant experience with Orace Integration Cloud (OIC) in creating automation workflows, configuring adaptors, and designing / building API integrations Expertise in Oracle enterprise applications like E-Business Suite (EBS), Fusion Applications, and Oracle Retail Suite Strong understanding of integration strategies and middleware, including SOA, microservices, and APIs Experience with other public cloud platforms (e.g., AWS, Azure) is a plus Experience with eCommerce platforms (ie HCL Commerce) is a plus Expereince with Infios WMS (ie Highjump) is a plus Proficiency with Microsoft Office Suite or related software Exceptional communication and presentation skills, with the ability to articulate complex technical concepts to executive-level stakeholders Strong analytical, problem-solving, and decision-making capabilities Proven leadership and collaboration skills, with experience leading cross-functional teams Ability to manage multiple priorities in a dynamic, fast-paced environment Working knowledge of Microsoft Office Suite. Comfortable navigating computer systems and software to assist customers or manage activities Physical Requirements Ability to maintain a seated or standing position for extended durations. Prolonged periods working at a computer. Occasional travel to stores/DCs as needed for deployments, audits, or incidents. Capability to lift 15 pounds periodically. Ability to navigate and access all facilities. Close vision for computer-related activities. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions. The pay range for this position is $135,000 - $170,000 annualized and is bonus eligible. Exact compensation is determined by factors such as relevant geographic location, education, certifications, experience, job level, shift, and organizational needs. To learn more about our benefits, review here ************************************************************************************
    $135k-170k yearly Auto-Apply 33d ago
  • Case Manager RN - Remote CST

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Required ScheduleMonday-Friday 8-5pm CST with flexibility needed to meet business needs. Position SummaryFacilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Potential for minimal travel as business needs arise. Required Qualifications• Active and good standing RN Compact License• Minimum 3+ years clinical practical experience required with preference for the following backgrounds: diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac with Medicare members. • Discharge Planning experience• Minimum 2+ years case management, discharge planning and/or home health care coordination experience Preferred Qualifications• Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills. • Ability to work independently (may require working from home). • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. • Efficient and Effective computer skills including navigating multiple systems and keyboarding • Willing and able to obtain multi state RN licenses if needed, company will reimburse expense• Bilingual preferred Education• Associates degree minimum required• BSN preferred• Certified Case Manager is preferred. • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $116,760. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $54.1k-116.8k yearly 5d ago
  • Medical Director (Medical Policy & Operations)

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryAetna, a CVS Health company, has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company?This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy & Operations) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. The Primary Responsibilities of this Medical Director role include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will:Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests. Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. Be a subject matter expert, internal consultant and payment policy contributor subject matter expertise and internal consultant. Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. Work Collaboratively with the functional areas. Required Qualifications*Five (5) or more years of experience in Health Care Delivery System e. g. , Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. *M. D. or D. O. , Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Preferred Qualifications* Health plan/payor experience. * Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Strong communication skills both written and verbal. Education* M. D. or D. O. , Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Pay RangeThe typical pay range for this role is:$174,070. 00 - $374,920. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/30/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $174.1k-374.9k yearly 7d ago
  • Utilization Management Nurse Consultant - Work at Home

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary SummaryAssesses and monitors patient health, administering medications and treatments, performing medical procedures, and collaborating with physicians and other healthcare professionals to develop and implement patient care plans. Educates patients and their families about healthcare management and assists in maintaining a safe and supportive healthcare environment. Primary Job Duties & ResponsibilitiesDrives effective utilization management practices by ensuring appropriate and cost-effective allocation of healthcare resources and facilitating appropriate healthcare services/benefits for members. Conducts routine utilization reviews and assessments, applying evidence-based criteria and clinical knowledge to evaluate the medical necessity and appropriateness of requested healthcare services. Collaborates with healthcare providers, multidisciplinary teams, and payers to develop and implement care plans that optimize patient outcomes while considering the efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare professionals by promoting effective utilization management strategies. Reviews and analyzes medical records, treatment plans, and documentation to ensure compliance with guidelines, policies, and regulatory requirements, subsequently providing recommendations for care coordination and resource optimization. Consults with and provides expertise to other internal and external constituents throughout the coordination and administration of the utilization/benefit management function. Communicates regularly with internal and external stakeholders to facilitate effective care coordination, address utilization management inquiries, and ensure optimal patient outcomes. Provides IC-related coaching and guidance to nursing staff and other healthcare professionals, sharing knowledge and expertise to enhance their understanding of utilization management principles and improve their clinical decision-making. Contributes to the development and implementation of utilization management strategies, policies, and procedures that aim to improve patient care quality, cost-effectiveness, and overall healthcare system performance. EducationBachelor's degree preferred/specialized training/relevant professional qualification. Prior Relevant Work Experience3-5 years Essential QualificationsWorking knowledge of problem solving and decision making skills. Working knowledge of medical terminology. Working knowledge of digital literacy skills. Ability to deal tactfully with customers and community. Ability to handle sensitive information ethically and responsibly. Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option. Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients. Registered Nurse (RN) required. Licensed Clinical Social Worker (LCSW) preferred. Requisition Job DescriptionPosition SummaryThis Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state. Normal Working Hours: Monday through Friday 8:30am-5:00pm in the time zone of residence. Shift times may vary occasionally per the need of the department. Rotational late shift 9:30-6CST. No travel is required. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing):Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Required QualificationsRN with active and unrestricted state licensure in their state of residence2+ years of acute hospital clinical experience as an RN with preference for medical-surgical and ICU experience (team is not accepting applicants whose only acute care experience is in behavioral health) Preferred Qualifications1+ years' experience Utilization Review experience1+ years' experience Managed Care Strong telephonic communication skills1+ years' experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook) Experience with computers toggling between screens while using a keyboard and speaking to customers. Ability to exercise independent and sound judgment, strong decision-making skills, and well-developed interpersonal skills Ability to manage multiple priorities, effective organizational and time management skills required Ability use a computer station and sit for extended periods of time EducationAssociate Degree in Nursing is minimum required, BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$29. 10 - $62. 32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $29 hourly 3d ago
  • Medical Director - Medical Affairs (Oncology)

    CVS Health 4.6company rating

    Work from home job in Kansas, IL

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position SummaryCVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs (Oncology) We need a Board Certified Oncologist for this opportunity. This is a remote based from from home role. The Medical Affairs department provides clinical business support to the entire enterprise and provides clinical oversight and mentorship for CVS Health clinical programs, PBM Clinical Quality activities, consultative support to the P&T process, formulary development, drug information services and pipeline activities, and provision of clinical leadership to various internal departments (e. g. , specialty pharmacy services, clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director (Medical Affairs) will report into the Medical Affairs Department and is responsible for clinical support and consultative activities across the PBM. In this role you may provide consultative clinical support to Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies. Medical Directors at CVS Health are encouraged to model the highest levels of clinical integrity, knowledge and cross functional thinking and decision making. Medical Directors represent the clinical decision making and professional thought process of the prescriber as a partner across the enterprise's decisions and planning. - Each Director is responsible for providing oversight of a portion of CVS Health's clinical programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors will spend a portion of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) programs and individual client requested coverage determinations or appeals when appropriate. - Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment (i. e. , Medicare clients), each director will become sufficiently skilled in various UM programs to support other segments (including commercial and Medicaid) on evening and weekend coverage. -In this role you'll perform a share of special clinical investigations and research as requested by the Senior Medical Director, Medical Affairs. These projects can include brief reviews of published literature around specific pharmaceutical questions or more in-depth projects requiring collaboration with pharmacists within Medical Affairs and in business units outside of the Department. CVS Health, a Fortune 5 company, has an outstanding opportunity for a Medical Director (Medical Affairs). Required Qualifications* Minimum of 5 years clinical experience in direct patient care. * Board Certified in Hematology/Oncology. * 2 or more years proven experience in clinical outcomes, with a solid understanding of medical statistics, regulatory agencies, and analytic programs. *Unrestricted license to practice medicine in the state in which the candidate is located. Preferred Qualifications* Additional Board Certification in Internal Medicine is highly preferred. * Combination of five years of management and/or clinical experience in a managed care environment and health administration, including adequate clinical experience in direct patient care and working with professionals at different levels as a teammate (e. g. , RNs, PharmDs, etc. ). * Master's Degree in Public Health Administration, MBA, and/or UM/QA certification. * Proficiency in MS Office Suite, including Teams and Outlook. Education* M. D. or D. O. , Current and Active Board Certification in ABMS or AOA recognized specialty; Oncology, Internal Medicine. * Possess an unrestricted active license to practice medicine in a State, Territory, Commonwealth of the United States, or the District of Columbia. * Up to date in Continuing Medical Education (CME) requirements for board certification(s) and licensure (must remain skilled in medical and management areas during employment). Pay RangeThe typical pay range for this role is:$174,070. 00 - $374,920. 00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $174.1k-374.9k yearly 30d ago

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