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 Summary The OhioRISE (Resilience through Integrated Systems and Excellence) program is a specialized Medicaid managed care initiative focused on providing and coordinating behavioral health services for eligible children and youth. The Manager, UM Clinical Health Services serves as a key Behavioral Health leader within the Aetna Medicaid plan, overseeing utilization management activities. This role is responsible for the oversight, development, and performance of clinical teams, including driving high-quality processes, ensuring compliance, and fostering strong team performance. This is a full-time, fully remote position. Eligible candidates must reside within the state of Ohio. Fundamental Components - Reinforces clinical philosophy, programs, policies and procedures. - Communicates strategic plan and specific tactics to meet plan. - Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. - Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. - Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. - Will be accountable for meeting the financial, operational and quality objectives of the unit. - Will be accountable for the day-to-day management of team(s) for appropriate implementation and adherence with established practices, policies and procedures. - Works closely with other functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. - Develop, initiate, monitor and communicate performance expectations. - May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers. - Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills. - Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams. - Consistently demonstrates the ability to serve as a model change agent and lead change efforts. - Accountable for maintaining compliance with policies and procedures and implements them at the employee level. - Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes. Required Qualifications - Ohio resident - Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric specialty, certification, or experience - 5+ years of clinical practice experience in behavioral healthcare - 2+ years utilization management experience is required (preferably in a managed care setting) - 2+ years of demonstrated healthcare leadership experience required (preferably in a managed care setting) - 2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications - 1+ year(s) of experience with electronic medical records - Must possess reliable transportation and be willing and able to travel in-state up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy. - Ability to work core business hours, Monday-Friday, 7:30am-5pm EST, with flexibility to work on call occasional weekend hours is required. - Must have high speed internet access Preferred Qualifications - Managed care/utilization management experience strongly preferred - Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment - Medicaid experience - If RN, BSN degree preferred Education - If Behavioral Health: Master’s degree in a field leading to independent Behavioral Health clinical licensure (LCSW, LPCC, LMFT - If Registered Nurse: Master's degree or equivalent experience in clinical area of expertise (e.g. bachelor's degree plus 7 years' experience; associate's degree or RN diploma plus 9 years' experience). Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $87,035.00 - $187,460.00 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. 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: 03/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Anticipated End Date: 2026-03-23 Position Title: Medical Director Associate – CarelonRx Job Description: Medical Director Associate – CarelonRx Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered. CarelonRx delivers market-leading pharmacy benefit management and medication dispensing services to drive affordability and improve member outcomes. The Medical Director Associate- CarelonRx supports pharmacy prior authorization reviews to ensure turnaround time is met and we are in compliance with all Pharmacy Benefit Management regulatory requirements. How you will make an impact: - May provide clinical guidance for pharmacy prior authorizations using CarelonRx clinical guidelines. - Supports clinicians to ensure timely and consistent responses to members and providers. - Conducts peer-to-peer prior authorization reviews for medications with attending physicians or other ordering providers to discuss review determinations. - Will participate in a physician on-call weekend rotation for a 24x7 unit. Minimum Requirements: - Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). - Must possess an active unrestricted medical license to practice medicine or a health profession. - Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US. - Minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Preferred Qualifications: - Utilization management experience preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $231504.00 to $396864.00. Location(s): California, Nevada, Illinois, Washington state. In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits 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. Job Level: Director Equivalent Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Physician/Doctor/Dentist Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

Anticipated End Date: 2026-03-27 Position Title: Medical Management Nurse Job Description: Medical Management Nurse Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 8:00am to 5:00pm depending on your time zone and occasional weekends. AmeriBen is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies. How you will make an impact: - Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. - Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources. - Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members’ aggregate symptoms and information. - Assesses member clinical information and recognizes when a member may not be receiving appropriate type, level, or quality of care, e.g., if services are not in line with diagnosis. - Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems appropriate. - May make recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience. - Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged. - Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear. Serves as a resource to lower-level nurses. - May participate in intradepartmental teams, cross-functional teams, projects, initiatives and process improvement activities. - Educates members about plan benefits and physicians and may assist with case management. - Collaborates with leadership in enhancing training and orientation materials. - May complete quality audits and assist management with developing associated corrective action plans. - May assist leadership and other stakeholders on process improvement initiatives. - May help to train lower-level clinician staff. Minimum Requirements: - Requires a minimum of associate’s degree in nursing. - Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background. - Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required. - Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities and Experiences: - Prior healthcare third party vendor (TPA) experience. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $75,772 to $113,658. Locations: Illinois In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits 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. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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 Summary Aetna, 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 Range The typical pay range for this role is: $174,070.00 - $374,920.00 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. 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 https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/20/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.