CVS Health

Role Description Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. - Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. - Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. - Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. - Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. - Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. - Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. - Utilizes case management processes in compliance with regulatory and company policies and procedures. - Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Qualifications - Minimum 3-5 years clinical practical experience required - Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience preferred - Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually - Excellent analytical and problem-solving skills - Effective communications, organizational, and interpersonal skills - Ability to work independently - Effective computer skills including navigating multiple systems and keyboarding - Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications - Candidates must live in Illinois Preferred Qualifications - Certified Case Manager is preferred - Bilingual preferred Education - Associates required, Bachelor's preferred License - Must possess active and unrestricted Registered Nurse license in Illinois Anticipated Weekly Hours - 40 Time Type - Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00. This 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. Benefits - Comprehensive and competitive mix of pay and benefits - Medical, dental, and vision coverage - Paid time off - Retirement savings options - Wellness programs - Other resources, based on eligibility Company Description 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.

Role Description We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a 6-month PRN contract position; provider must be able to provide a minimum of 9 hours of availability per week including every third weekend. The available shift times are evening (2:30p - 11p) and overnight (9p - 6:30a). The Minute Clinic Virtual Care Nurse Practitioner (Provider) delivers patient care services through a remote technology platform. You will work in collaboration with a dedicated team of professionals as you independently provide holistic, evidenced based care inclusive of: - Accurate assessment - Diagnosis - Treatment - Management of health problems - Health counseling - Disposition planning for patients ranging in age 18 months and above Encounters are documented utilizing Epic. Working Environment: - Dedicated virtual care providers must meet minimum requirements for remote care delivery, including: - Broadband connectivity - A quiet setting with a neutral background to conduct visits from - The ability to uphold patient privacy per CVSH guidelines - Ability to hardwire into connection preferred - Regularly required to interact with customers in a remote manner, sit, write, operate the computer and phone, speak intelligibly, and hear patient responses - Specific vision abilities include the ability to view and read a computer screen and other electronic devices Responsibilities: - Provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients. - Evaluate primary care, acute, chronically ill, and transitional care patients, in addition to providing healthcare education and counseling, and disposition planning for our patients ranging in age 18 months and above. - Provide patient counseling; inclusive of pregnancy prevention, STI Prevention/safer sex practices, contraceptive care counseling and medication management. - Educate patients on health maintenance and respond to patient care inquiries. - Document all patient care within an EHR according to MinuteClinic policies and procedures. - Provide care and coordination of our patients with internal and external colleagues, including the broader patient centered medical home, ensuring the highest standard of care is provided for all patients. - Effectively work within a patient care team, including fellow Providers, Collaborative Physicians, paraprofessionals, Pharmacists and other members of the health care team. - Work independently, prioritize and solve problems, take initiative, and advocate for their patients and their practice. Qualifications - Currently licensed in one of the following states: AL, AR, CO, IA, ID, IN, LA, MI, MS, NE, NV, OK, TN, or TX. - Minimum of two years of medically-relevant experience or equivalent. - Effective verbal, written, and electronic communication skills. - Outstanding organizational skills and ability to multi-task. - Initiative, problem solving ability, adaptability and flexibility. - Ability to work without direct supervision and practice autonomously. - Proficient with information management and technology. - Capacity to collaborate with professional colleagues as necessary to provide quality care. - Depending on the market, proficiency in both speaking and writing in additional languages, including Spanish, may be required. Education - Completion of a Master’s Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role required. Pay Range The typical pay range for this role is: $37.66 - $90.13. This 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. Benefits - Comprehensive and competitive mix of pay and benefits. - Part-time position eligible for a range of benefits and programs that support the physical, emotional, and financial well-being of colleagues. - Depending on hours worked and eligibility, benefits include dental, vision, wellness resources, employee discounts, access to certain voluntary benefits, and other programs. - Additional details about available benefits are provided during the application process. Application Information We anticipate the application window for this opening will close on: 07/31/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Role Description Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. - Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. - Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. - Interacts with members/clients telephonically or in person; may be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. - Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. - Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. - Prepares all required documentation of case work activities as appropriate. - Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. - May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. - Provides educational and prevention information for best medical outcomes. - Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. - Testifies as required to substantiate any relevant case work or reports. - Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. - Utilizes case management processes in compliance with regulatory and company policies and procedures. - Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. - Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration. - Monitors member/client progress toward desired outcomes through assessment and evaluation. Qualifications - 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. - 2+ years case management, discharge planning and/or home health care coordination experience. - Candidate must have active and unrestricted Compact Registered Nurse (RN) License in their state of residence. Requirements - 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 single state Registered Nurse (RN) licenses if needed; company will provide. - Certified Case Manager. - National professional certification (CRC, CDMS, CRRN, COHN, or CCM). Education - Associate's Degree in Nursing or Nursing Diploma (REQUIRED). - Bachelor's Degree in Nursing (PREFERRED). License - Active and unrestricted Compact Registered Nurse (RN) License in their state of residence. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00. This 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. Benefits This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include: - Medical, dental, and vision coverage. - Paid time off. - Retirement savings options. - Wellness programs. - Other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

• 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. • Typical office working environment with productivity and quality expectations • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor • Sedentary work involving periods of sitting, talking, listening • Work requires sitting for extended periods, talking on the telephone and typing on the computer • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding • Effective communication skills, both verbal and written

• Monitor application performance, system health, and alerts using APM tools such as AppDynamics, Grafana, and Splunk • Act as the primary point of contact for incident management and service requests • Conduct initial triage, classify issues, and prioritize tickets in alignment with SLAs and SLIs • Resolve routine issues by leveraging runbooks and established standard operating procedures • Escalate complex incidents to L2/L3 support teams with comprehensive documentation • Provide timely communication on incident status, updates, and resolutions to stakeholders and end users • Work within REST APIs, microservices-based architectures, and cloud platforms (AWS, Azure, GCP) • Troubleshoot and debug SQL queries across relational and non-relational databases • Support CI/CD pipelines and assist with deployment-related troubleshooting • Automate repetitive operational activities using scripting languages such as Python and Shell • Maintain, update, and enhance runbooks, knowledge repositories, and SOPs • Perform in-depth troubleshooting across applications, APIs, and underlying infrastructure • Analyze logs, metrics, and traces to identify and resolve root causes • Debug application issues at the code level (preferably in Java, Python, or similar technologies) • Implement data corrections, configuration changes, and minor code or script updates • Collaborate with engineering teams to deploy bug fixes, enhancements, and patches • Participate in post-incident reviews and contribute to root cause analysis (RCA) initiatives

• Routinely handles complex cases involving behavioral health or multi-disciplinary provider groups in a prepayment environment • Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. • Researches and prepares cases for clinical and legal review. • Documents all appropriate case activity in case tracking system. • Prepares and presents referrals, both internal and external, in the required timeframe. • Facilitates the recovery of company lost as a result of fraud matters. • Assists team in identifying resources and best course of action on investigations. • Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. • Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings. • Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud. • Provides input regarding controls for monitoring fraud related issues within the business units. • Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations of fraud and abuse

• Complete In-home Visits • Perform IHEs, Focused Visits as well as Video Visits, exemplifying the highest standards of Signify Health key performance indicators and metrics (includes operational, clinical, and member experience KPIs) • Test new Diagnostic & Preventive Services (DPS) and clinical workflow changes and provide feedback • Provide 40 hours of availability weekly, consistently providing 128+ capacity units per month • Reserve one assigned day/week for coaching and mentorship activities • Execute a strong visit completion rate, consistently pacing 88+ completed visits per month • Provide dedicated guidance in the first 90 days to new hire clinicians • Facilitate virtual and in-person shadowing opportunities for new clinicians to observe and learn • Offer Group Support to active clinicians on new features/DPS/updates of a clinical nature as well as areas of opportunity • Serve as first line of response for clinical inquiries before escalating to Clinical Leader (CL)

• Ability to build and lead a specialized team responsible for the effective execution of contract management obligations • Oversee the full contract lifecycle, including drafting, negotiation, approval, execution, and renewal • Ensure proper documentation, execution, and handoff of contracts across internal stakeholders • Establish and enforce contract governance processes, documentation standards, and approval workflows • Track contract status, performance, and closure metrics to ensure accountability • Monitor ongoing compliance with contractual obligations and performance guarantees • Lead the development and execution of contract strategies across clients, vendors, and/or providers • Negotiate complex contract terms, including financial arrangements, performance guarantees, service level agreements, and the RTN process • Drive strategic partnerships with internal stakeholders

Role Description We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Schedule is Monday-Friday 8am - 5pm MST/PST. One late day/night a week. No weekends and no holidays. This is a fully telework role. Anywhere in Continental US. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through: - Assessment and care planning - Direct provider coordination/collaboration - Coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes Assessment of Members: - Conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution by evaluating member’s benefit plan and available internal and external programs/services. - Applies clinical judgment to incorporate strategies designed to reduce risk factors and address complex clinical indicators impacting care planning and resolution of member issues. - Performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to appropriate clinical providers for thorough assessment and treatment. - Provides crisis follow-up to ensure members are receiving appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care: - Application and/or interpretation of applicable criteria and clinical guidelines while assessing benefits and/or member’s needs. - Consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. - Presents cases at case conferences to obtain multidisciplinary views for optimal outcomes. - Identifies and escalates quality of care issues through established channels. - Speaks to medical and behavioral health professionals to influence appropriate member care. - Utilizes influencing/motivational interviewing skills to ensure maximum member engagement. - Provides coaching, information and support to empower members to make ongoing independent medical and/or healthy lifestyle choices. - Helps members actively participate with their provider in healthcare decision-making. - Analyzes all utilization, self-report and clinical data to identify comprehensive member needs. Monitoring, Evaluation and Documentation of Care: - In collaboration with the member and their care team, develops and monitors established plans of care to meet member’s goals. - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines. - Must be able to multitask. Qualifications - Masters prepared behavioral health clinician with unrestricted Independent Behavioral Health licenses in the state where they work (LPC, LCSW, LISW, LMFT, LCMHC, PsyD). - 3+ years of direct clinical practice experience post master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility. - 3+ years experience with mental health and/or substance abuse disorders. - 3+ years Microsoft Suite experience (e.g., Word, Excel). - 3+ years using documentation systems. Requirements - Crisis Intervention skills. - Managed care experience. - Case Management and discharge planning experience. - Motivational Interviewing skills. Education - Minimum of a Master’s degree in Behavioral/Mental Health or related field. Anticipated Weekly Hours - 40 Time Type - Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00. This 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. Benefits - Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. - Medical, dental, and vision coverage. - Paid time off. - Retirement savings options. - Wellness programs and other resources, based on eligibility. We anticipate the application window for this opening will close on: 07/20/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Role Description Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. - Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. - Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. - Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. - Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. - Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. - Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. - Utilizes case management processes in compliance with regulatory and company policies and procedures. - Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Qualifications - This position will typically be a Work from Home role; however, candidates must possess reliable transportation and be willing and able to travel up to 30% of the time if needed, in and around candidate's home location. Mileage is reimbursed per our company expense reimbursement policy. - 3-5 years of direct clinical practice experience e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility. - Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually. - Excellent analytical and problem-solving skills. - Effective communications, organizational, and interpersonal skills. - Ability to work independently. - 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. Requirements - Case management and discharge planning experience. - Managed care/utilization review experience. - Crisis intervention skills. - Certified Case Manager. - Bilingual. Education and Certification Requirements - Associate's Required, Bachelor's preferred. - Active and Unencumbered Registered Nurse License in Illinois. Benefits - Medical, dental, and vision coverage. - Paid time off. - Retirement savings options. - Wellness programs. - Other resources, based on eligibility. Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00. This 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.