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Cvs Health Utilization Management Remote Jobs in Alabama

Bcbsa

$155K - $175K/yr

... in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

New

Lycored

Lycored Health Sales Account Manager REMOTE (USA)Location: Remote, USAReports to: Head of Global ... (or similar). • Ability to thrive in a remote/virtual work environment.Key Competencies • ...

Sentara

Senior Healthcare Data Analyst - Remote

Centre, AL · Remote

$81K - $102K/yr

This position is fully remote. Overview The Healthcare Data Analyst Senior provides data analysis ... Experience in Epic, claims, quality,utilization, finance, operations, service lines, population ...

Sentara

Senior Healthcare Data Analyst

Centre, AL · Remote

$80K - $133K/yr

This position is fully remote. Overview The Healthcare Data Analyst Senior provides data analysis ... Experience in Epic, claims, quality,utilization, finance, operations, service lines, population ...

Arcoro

Account Manager - Remote

Birmingham, AL · Remote

... management and forecasting experience, including the ability to assess opportunity health, maintain ... Hybrid/Remote Work About the Company A rapidly growing SaaS company, Arcoro offers proven modular H ...

Arcoro

Account Manager - Remote

Birmingham, AL · Remote

... management and forecasting experience, including the ability to assess opportunity health, maintain ... Hybrid/Remote Work About the Company A rapidly growing SaaS company, Arcoro offers proven modular H ...

Arcoro

Account Manager - Remote

Birmingham, AL · On-site +1

$60K - $70K/yr

... management and forecasting experience, including the ability to assess opportunity health, maintain ... Hybrid/Remote Work About the Company A rapidly growing SaaS company, Arcoro offers proven modular H ...

Harris

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 ...

Aprio

Senior Director, Resource Management

Birmingham, AL · On-site +1

$225K - $300K/yr

Analyze trends in utilization and availability to drive redeployment of team members across offices ... remote and hybrid options What's in it for you: - Working with an industry leader : Be part of a ...

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Cvs Health Utilization Management Remote information

What is the difference between Cvs Health Utilization Management Remote vs Cvs Health Medical Reviewer?

AspectCvs Health Utilization Management RemoteCvs Health Medical Reviewer
CredentialsRN, LPN, or other healthcare licensesRN, MD, or DO licenses
Work EnvironmentRemote, home-basedRemote or onsite, depending on role
Employer & Industry UsageUtilization management for insurance approvalsMedical review for claims and authorizations

Both roles involve healthcare assessments, often requiring similar licenses. Utilization Management Remote focuses on reviewing medical necessity for insurance purposes, while Medical Reviewers may handle detailed case evaluations. Both are remote-friendly and integral to healthcare insurance processes, but differ slightly in scope and responsibilities.

What are popular job titles related to Cvs Health Utilization Management Remote jobs in Alabama? For Cvs Health Utilization Management Remote jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Cvs Health Utilization Management Remote jobs in Alabama look for? The top searched job categories for Cvs Health Utilization Management Remote jobs in Alabama are:
What cities in Alabama are hiring for Cvs Health Utilization Management Remote jobs? Cities in Alabama with the most Cvs Health Utilization Management Remote job openings:
Cvs Health Utilization Management Remote jobs near you
Infographic showing various Cvs Health Utilization Management Remote job openings in Alabama as of July 2026, with employment types broken down into 55% Full Time, 40% Part Time, 4% Contract, and 1% Summer. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.

Director, Trade Client Relations

Bcbsa

Remote

$155K - $175K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 2 days ago

Job description

Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability and access to costly medical benefit drugs - ones that are injected or infused by a health care professional in a clinical setting - for nearly 100 million Americans. The Trade Client Strategy Director liaises with Synergie Participants and manages clinical policies to comply with manufacturer contracts, implements Trade strategies and initiatives, and collaborates with and supports Synergie's Client Relations team for Trade related inquiries. This includes medical and pharmacy drug policies, cross benefit management, and rebate qualification for manufacturer contracts. This position will establish and maintain cross functional partnerships with internal teams to drive the identification, development and successful execution of Synergie's rebate programs. This position will be the primary Trade point of contact for Synergie's Participant facing activities and will support clinical decision making at the Participant level to comply with manufacturer contracts.

Primary Job Functions

  • Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants

  • Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies

  • Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation

  • Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria

  • Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance

  • Collaborate and support Client Relations team for Trade related inquiries from Participants

Partner with the following stakeholders:

  • Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies

  • Client Relations - Serve as Trade's primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade's leadership

  • Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

  • Invoicing Team - Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies

  • Product Team - Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs

Education, Experience, and Certification

  • Pharmacy degree and Pharm D. preferred

  • 5-7 years of related work experience in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical contracting, client relations, or analytical contracting

  • Must be eligible to work in the United States without need for work visa or residency sponsorship

  • Excellent verbal and written presentation skills

  • Ability to establish rapport and build relationships at all levels within an organization

  • Practical application of clinical data to drive financial value

  • Strong business and financial acumen, with advanced proficiency in Excel and PowerPoint

Knowledge, Skills, and Abilities

  • Pharmacy residency training or equivalent experience

  • Experience within the PBM industry, Medicaid, Medicare, and health plans

  • Experience with contract language and risk mitigation concepts

Travel Requirements: Up to 10% of the time.

Work is generally performed in a remote setting.

#LI-Remote

$155,000.00 - $175,000.00

This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.

We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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