by Terrance Ellis | Jan 26, 2026 | Uncategorized
This is a payer-contract and reimbursement strategy role built for someone who knows specialty pharmacy or home infusion inside and out. You’ll dig into contract terms, spot what’s missing or unfavorable, educate internal teams, and work with payer/provider relations to reduce denials, improve collections, and stay compliant.
About Soleo Health
Soleo Health is a national provider of specialty pharmacy and infusion services delivered in the home or alternate sites of care. Their focus is simplifying complex care while improving outcomes, backed by a culture centered on accountability, passion, and doing the right thing.
Schedule
- Full-time, remote
- Typical business hours: 8:30am–5:00pm (overtime as needed)
- No weekends or holidays
What You’ll Do
- Review payer contracts for key intake and reimbursement terms (timely filing, clean claim payment terms, fee provisions and fee schedules)
- Analyze fee schedules for common billable services (per diems, nursing, drugs)
- Partner with Managed Markets to address missing or unfavorable reimbursement terms
- Deliver clear analyses and recommendations to leadership (VP of Reimbursement and CFO or designees)
- Educate intake and reimbursement teams on payer policies, trends, and reimbursement practices
- Create and maintain reimbursement contract resource documents for internal use
- Build and maintain relationships with provider relations teams (contracted and non-contracted)
- Address trending issues like claim denials or payer non-compliance with contract terms
- Identify cost savings and improved cash collections through reimbursement trend analysis
- Contribute to internal/external discussions on payer strategy, contracts, and industry knowledge
- Manage direct reports (hiring, training, performance management, reviews, conflict resolution, goal setting, and strategic planning)
- Handle additional duties as assigned
What You Need
- High school diploma or equivalent (required)
- Bachelor’s degree OR 5+ years of reimbursement/account management experience with injectable/infused drugs or reimbursable medical device products
- Significant specialty pharmacy or home infusion experience (required)
- Proven experience with Medicare, Medicaid, and/or managed care reimbursement at both provider and payer levels
- Strong communication skills (verbal and written)
- Strong analytical, organizational, administrative, and team-building skills
- Solid problem-solving ability and comfort working cross-functionally
Benefits
- Pay: $70,000–$88,000/year
- Competitive wages
- 401(k) with match
- Referral bonus
- Paid time off
- Annual merit-based increases
- Paid parental leave options
- Medical, dental, and vision insurance plans
- Company-paid disability and basic life insurance
- HSA & FSA options (including dependent care)
- Education assistance program
- Great company culture
If you’ve got real home infusion/specialty pharmacy reimbursement chops and you like being the person who fixes the system behind the scenes, this is a serious opportunity.
Know the contracts. Protect the margin. Keep care moving.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Jan 26, 2026 | Uncategorized
This is a clinical-heavy, denial-prevention role built for someone who can read a complex chart, match it to payer criteria, and write appeals that actually win. If you’ve done infusion denial support and you’re strong with medical necessity language, this is a high-impact remote seat.
About Soleo Health
Soleo Health is a national provider of specialty pharmacy and infusion services delivered in the home or alternate sites of care. Their focus is simplifying complex care and improving patient outcomes, supported by a culture grounded in accountability, creativity, and doing the right thing.
Schedule
- Full-time, remote
- Monday–Friday, 8:30am–5:00pm Eastern Time
- No weekends or holidays
What You’ll Do
- Complete prior authorization clinical reviews by evaluating patient clinicals against payer medical necessity criteria
- Review progress notes, labs, infusion summaries, imaging, and plans of care to identify documentation that meets payer policy
- Request additional clinical information when needed to support decisions and next steps
- Build clinical support packets for initial authorizations and appeals
- For denials, write and document a clear, fact-based clinical case for appeal using nationally recognized medical necessity criteria
- Create and maintain an internal library of appeal templates, clinical resources, journal articles, and reference tools
- Stay current on payer medical policies, formularies, and coverage requirements and know how to locate payer resources quickly
- Assist with post-service denials and appeals
- Support outcome programs (data entry, reporting, and occasional patient calls as needed for denial support tasks)
- Provide training across departments on top disease states, specialty drugs, and best practices for prior auth and appeals
What You Need
- Bachelor’s degree in a healthcare field OR 3 years in a qualified position
- Experience with denial support, clinical reviews, and appeals for infusions (required)
- Preferred experience with specialty infusion patient needs and challenges
- Strong written, verbal, and presentation communication skills
- Strong customer service and interpersonal skills with a flexible communication style
- Ability to manage stress, prioritize, and meet program objectives
- Self-starter who is accountable and results-oriented
- Proficiency with Word, Excel, and PowerPoint
- Ability to communicate effectively across all levels of the organization
Benefits
- Pay: $68,000–$85,000/year
- Competitive wages
- Flexible schedules
- 401(k) with match
- Referral bonus
- Paid time off
- Annual merit-based increases
- Medical, dental, and vision insurance plans
- Company-paid disability and basic life insurance
- HSA & FSA options (including dependent care)
- Education assistance program
If your skill is turning “denied” into “approved,” this is your kind of role.
Build the case. Beat the denial. Get care started.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Jan 26, 2026 | Uncategorized
If you’re sharp with details and don’t mind being the person who catches mistakes before money moves, this role is a solid fit. You’ll review loan documents for accuracy and compliance, support dealers through the funding process, and keep files clean so funding doesn’t stall.
About Foundation Finance Company (FFC)
Foundation Finance Company is a fast-growing consumer finance company that partners with home improvement contractors across the U.S. to offer flexible financing options. They’ve been Great Place to Work® certified since 2017 and focus on a positive, supportive workplace.
Schedule
- Remote
- Must reside in one of these states for remote eligibility: AL, AR, AZ, CO, FL, GA, IL, IN, KY, LA, MD, MI, MN, MO, MS, NC, NJ, NV, NY, OH, OK, OR, SC, TN, TX, UT, VA, WA, WI
- Pay: $18.00–$19.00/hour
What You’ll Do
- Enter received financing documents into the operating system for processing
- Review loan/financing documents for accuracy and compliance with policies and regulations
- Monitor the e-signature queue and resend links or contact dealers to resolve issues
- Answer dealer questions about program processes and application status
- Train dealers on proper document completion and funding processes (phone/email)
- Document notes properly per company procedures
- Review processing statuses and documentation to ensure dealer calls are handled correctly
- Support other departments with document or funding-related questions
- Handle additional duties as assigned
What You Need
- High school diploma/GED (completed or in progress)
- Microsoft Office knowledge (Word, Excel, PowerPoint, Outlook, Internet Explorer)
- Ability to read and interpret manuals/procedures and related documents
- Ability to write routine reports and correspondence
- Ability to communicate clearly with customers/dealers and internal teams
- Strong attention to detail and ability to multitask under deadlines
- Reliable attendance and ability to adapt to change
Benefits
- Day-one health benefits (medical, dental, vision) plus HSA/FSA options
- 401(k) with company match (day-one enrollment)
- Paid sick and volunteer time off
- Paid parental leave options
- Employer-paid life and disability insurance
- Wellbeing on Demand program
- Flexible work environment with casual dress code
- Note: Some benefits may vary by employment status and may start after a waiting period
If you like structured work, tight processes, and being the reason deals don’t get delayed, this is a good one to move on.
Be the closer behind the scenes.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Jan 26, 2026 | Uncategorized
If you want a role where your calls actually move the needle for people with complex needs, this one’s built for that. You’ll support dual-eligible (Medicare + Medicaid) DSNP members, helping connect medical care, social support, and preventive follow-through into one clear plan.
About CVS Health (Aetna Care Management)
Aetna’s care management teams support members with complex health and social needs, partnering with providers, community resources, and internal clinical teams to improve outcomes and close care gaps.
Schedule
- Full-time (40 hours/week)
- Remote (Work at Home)
- Location listed: Ohio
What You’ll Do
- Conduct annual Health Risk Surveys to identify needs and support each member’s Individual Plan of Care
- Coordinate care tasks delegated by the Care Manager, within established timelines
- Escalate newly identified health/safety risks, service needs, and any quality-of-care concerns
- Support members by addressing social determinants of health (SDoH) and connecting them to resources
- Use problem-solving to locate hard-to-reach members and improve engagement
- Apply motivational interviewing techniques to encourage participation and healthier choices
- Document activity and follow case management processes aligned to regulatory/accreditation requirements
- Meet productivity and compliance metrics (call volume, engagement, regulatory standards)
What You Need
- 2+ years in behavioral health, social services, or a related field aligned to the program
- Strong comfort with Microsoft Office (Word, Excel, Outlook, OneNote, Teams)
- A private, dedicated workspace for remote work
- High School Diploma + equivalent experience (required)
Nice to Have
- Case management and/or discharge planning experience
- Managed care experience
- Associate’s/Bachelor’s degree (or master’s level behavioral health/human services clinician background)
Benefits
- Pay range: $21.10 – $40.90/hr (plus bonus/short-term incentive eligibility, where applicable)
- Medical plan options, 401(k) with matching, employee stock purchase plan
- Wellness programs, counseling, financial coaching
- PTO, flexible schedules, family leave, tuition assistance, and more (eligibility-based)
Application window closes: 01/29/2026
If you’re actually considering applying, do this next: paste your current resume bullets (or your last 2 roles), and I’ll rewrite them so they line up with care coordination, SDoH, member engagement, documentation, and motivational interviewing without overreaching.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Jan 26, 2026 | Uncategorized
Build and improve the search experience across CVS Health’s digital platforms using modern search tech, machine learning, and data analysis. This role sits at the intersection of relevance tuning, scalable infrastructure, and next-gen search enhancements (including LLM and RAG approaches).
About CVS Health
CVS Health is focused on making health care more connected, convenient, and compassionate through its local footprint and digital channels. Their teams build technology that supports millions of people and helps simplify health care for individuals and communities.
Schedule
- Full-time (40 hours/week)
- Remote
What You’ll Do
- Develop and optimize search algorithms and systems using Elastic, OpenSearch, and/or Solr
- Improve search relevance using machine learning approaches (classification and ranking models)
- Build scalable search infrastructure using Kubernetes, Kafka, and search platforms (Elastic/Solr/OpenSearch)
- Explore and implement modern search enhancements like agentic solutions, RAG, and LLMs
- Analyze search queries, user behavior, and performance metrics to identify and deliver improvements
- Partner with product, engineering, and business stakeholders to gather requirements and ship solutions
- Develop and evaluate predictive and analytical models to solve search-related problems
- Use Python, Kotlin, and/or Java to examine and interpret large-scale search data
- Communicate technical concepts clearly to both technical and non-technical audiences
What You Need
- 5+ years of experience in search engineering, information retrieval, or a related field
- 3+ years programming with Python or Java/Kotlin
- 3+ years working with Elastic, OpenSearch, Solr, or similar open-source search engines
- 3+ years experience with SQL and/or NoSQL databases
- Bachelor’s degree or equivalent experience (HS diploma + 4 years relevant experience)
Benefits
- Pay range: $92,700 – $222,480 (plus bonus/short-term incentive eligibility)
- Medical plan options and wellness programs
- 401(k) with matching contributions
- Employee stock purchase plan
- Paid time off, family leave, tuition assistance, and more (eligibility-based)
The application window closes soon. If you want it, don’t drag your feet.
Help shape search that’s faster, smarter, and more useful at massive scale.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Jan 26, 2026 | Uncategorized
A senior, enterprise-level architecture role focused on applied Generative AI and how it gets safely and scalably embedded into real business applications. You’ll shape CVS Health’s AI reference architectures, patterns, and roadmap decisions across a complex tech ecosystem.
About CVS Health
CVS Health is building a more connected, convenient, and compassionate health care experience. With a national footprint and a massive digital and clinical reach, they’re investing heavily in technology that simplifies care for individuals and communities.
Schedule
- Full-time (40 hours)
- Remote (USA)
- Location flexibility: can work remotely from anywhere in the U.S.
What You’ll Do
- Define and drive future-state reference architectures for applied AI across the enterprise
- Create roadmaps, standards, patterns, best practices, and starter-code reference implementations
- Evaluate market trends and guide buy vs. build decisions tied to business outcomes and cost
- Consult with technology and business partners to adopt AI responsibly across business applications
- Lead creation of reusable AI patterns that increase speed to market, reduce cost, and manage risk
- Ensure non-functional requirements are clearly defined (performance, security, availability, scalability, failover)
- Mentor and coach architects and delivery teams through POCs, starter code, and architectural enablement
- Help define long-term architecture strategy in a complex, large-scale environment
What You Need
- 15+ years of relevant experience (including 10+ years in architecture)
- 10+ years designing complex solutions and enabling implementation through mentoring/POCs
- Deep, hands-on applied AI architecture experience, including:
- GenAI models and pipelines
- Fine-tuning and prompt engineering
- RAG architectures and vector stores
- MCP, LangChain, LangGraph (or similar frameworks and agent tooling)
- Strong experience in requirements analysis, estimation, systems design, and testing
- Expert-level understanding of architecture methodologies, standards, governance, patterns, and best practices
- High-impact collaboration and influence skills across technical and business stakeholders
Benefits
- Competitive pay range: $175,100 – $334,750 (plus bonus/incentives and equity target program)
- Medical plan options and wellness programs
- 401(k) with matching contributions
- Employee stock purchase plan
- Paid time off, family leave, tuition assistance, and more (eligibility-based)
Application window closes soon. If it’s on your list, move on it.
Build the blueprint for enterprise AI that teams can actually ship against.
Happy Hunting,
~Two Chicks…
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