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. Position Information Schedule: Monday–Friday 8:00am-5:00pm EST Location: 100% Remote (U.S. only) 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 Summary Join a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect. Key Responsibilities - Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. - Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client. - Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. - Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and feedback. - Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet client needs. - Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction. - Must be able to work independently without personal distractions to meet quality and metric expectations. Remote Work Expectations - This 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 Qualifications - Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. - Minimum 3 years of clinical experience. - 5 years demonstrated to make thorough independent decisions using clinical judgement. - 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. - 1+ Year of Utilization Review Management and/or Medical Management experience. - Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications - Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. - MCG Milliman, CPB or other criteria guideline application experience is preferred. Education - Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 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. 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 https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Job DetailsJob Location: MO, Jefferson City - Missouri Regional Office - JEFFERSON CITY, MO 65109Position Type: Per DiemEducation Level: Professional DegreeJob Shift: DayJob Category: Medical Physician & Advanced Practice ProviderCenturion Health is proud to be the provider of healthcare services to the Missouri Department of Corrections. a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } We are seeking a PRN Primary Care Telehealth Physician to join our Missouri Regional Office team, providing telehealth services to patients in correctional facilities across the state. This remote role allows you to deliver high‑quality care to an underserved population while supporting facilities throughout Missouri. The Physician (Telehealth) provides medical assessments and evaluations in addition to treatment for emergent, urgent, and routine medical issues. The Physician remotely supervises medical treatment for chronic medical conditions and participates in organizational initiatives to help prevent diseases and injuries of patients under the direction of the Site Medical Director and/or the Statewide Medical Director. This professional collaborates with the Health Services Administrator (HSA) to ensure that efficient and clinically appropriate medical services are provided. Qualifications MD/DO BC/BE in FM, IM or EM Active, clean Missouri Medical License Active DEA Active MO BNDD Ability to pass background check and credentialing Available Shift PRN Monday - Friday Day Shift No nights, holidays or weekends Centurion Health provides our PRN team members with company paid malpractice. About Us Centurion Health contracts with state and local governments nationwide to provide comprehensive healthcare services to correctional facilities, state hospitals, and other community settings. Our dedication to making a difference and our passionate team of the best and the brightest healthcare employees has made us one of the leaders of the correctional health industry. Whether you are driven by purpose and impact or on a journey of professional growth, our opportunities can offer both. For additional information, contact Tiffany Walden, Provider Recruiter at twalden@teamcenturion.com or call/text 615-240-7235. indmhm

Job DetailsJob Location: MO, Jefferson City - Missouri Regional Office - JEFFERSON CITY, MO 65109Position Type: Per DiemEducation Level: Professional DegreeJob Shift: DayJob Category: Medical Physician & Advanced Practice ProviderCenturion Health is proud to be the provider of healthcare services to the Missouri Department of Corrections. a { text-decoration: none; color: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-color: #f5f5f5; } We are seeking a PRN Primary Care Telehealth Physician to join our Missouri Regional Office team, providing telehealth services to patients in correctional facilities across the state. This remote role allows you to deliver high‑quality care to an underserved population while supporting facilities throughout Missouri. The Physician (Telehealth) provides medical assessments and evaluations in addition to treatment for emergent, urgent, and routine medical issues. The Physician remotely supervises medical treatment for chronic medical conditions and participates in organizational initiatives to help prevent diseases and injuries of patients under the direction of the Site Medical Director and/or the Statewide Medical Director. This professional collaborates with the Health Services Administrator (HSA) to ensure that efficient and clinically appropriate medical services are provided. Qualifications MD/DO BC/BE in FM, IM or EM Active, clean Missouri Medical License Active DEA Active MO BNDD Ability to pass background check and credentialing Available Shift PRN Monday - Friday Day Shift No nights, holidays or weekends Centurion Health provides our PRN team members with company paid malpractice. About Us Centurion Health contracts with state and local governments nationwide to provide comprehensive healthcare services to correctional facilities, state hospitals, and other community settings. Our dedication to making a difference and our passionate team of the best and the brightest healthcare employees has made us one of the leaders of the correctional health industry. Whether you are driven by purpose and impact or on a journey of professional growth, our opportunities can offer both. For additional information, contact Tiffany Walden, Provider Recruiter at twalden@teamcenturion.com or call/text 615-240-7235. indmhm

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are currently looking for NPs licensed ideally in some of the following core states: FL, TX, CA, GA, NY, WA, CO, PA, NC. As part of the FOLX Clinical team, you will be providing evidence-based clinical care to our members (patients). As a FOLX Clinician, you will be providing clinical care to our members (patients) through a telehealth platform. The clinical services FOLX offers focus directly on the needs of the LGBTQAI+ community and include the following: - Trans/nonbinary gender affirming hormone therapy - Sexual and reproductive health - Primary care - Mental health care Our clinical care is provided both synchronously (all clinical visits are done through audio/visual format) as well as asynchronously (lab reviewing and resulting, answering members’ asynchronous clinical questions, etc.). Clinical care of our patients will always be your first priority, but there is regular time set aside for our clinical team to discuss case studies and attend clinical training sessions. Qualifications - Multiple active state NP licenses (Ideal state licenses include: FL, TX, CA, GA, NY, WA, CO, PA, NC, MI, ME, RI) - Ideal but not required: Compact RN license (expedites NP licensing in any compact states) - At least 1 state specific Federal DEA license - Active Controlled Substance Registration/Licensure if required in your state(s) of practice - Master's degree or equivalent from a college or university - National Certification through appropriate licensing authority - Ideal but not required: 30 contact hours Continuing Education or a 15 week college level course in pharmacology within the last 2-3 years - Clinical experience serving the LGBTQAI+ community - Organizational and time management skills that allow for timely completion of charts and member care in a remote work environment - Self-motivation, independence, and willingness to work in a rapidly changing environment - Ability to learn new apps, programs, and proficiency with virtual meeting platforms Benefits - Biweekly pay - Simplified tax withholding - Access to a 401(k) plan - Malpractice insurance coverage - Learning budget - Wellness & community reimbursement Company Description FOLX Health exists to be the leading health and wellness platform for LGBTQIA care, providing end to end services, both virtually and in person, across the spectrum of community needs. We are the north star for innovation in the broader ecosystem by creating joyful, affirming healthcare on one's own terms and building community and access around those needs. Additional Information Rate: $85 for 30 min appt (inclusive of admin time), $42.50 for 15 min appt (inclusive of admin time). We are proud to be an equal opportunity employer, and do not discriminate on the basis of race, color, ethnicity, national origin, religious affiliation, sex, gender identity, sexual orientation, disability, or any other legally protected status. Here, diversity and inclusion means accepting that everyone’s perspective can teach you something. We’re eager to learn. Please note: There has been a recent increase in employment scams. FOLX posts all of our open positions on our careers page at www.folxhealth.com/careers and only contacts candidates from official "@folxhealth.com" email addresses.