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 full-time telework position with less than 5% travel required. The schedule for this role is Monday-Friday 8:30a-5p in time zone of residence. Position Summary This RN Case Manager position is remote and candidates can apply from any state but must work the stated hours. There is a preference for nurses in a compact RN licensure state, however, that is not required. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate overall wellness. - Collaboratively 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 overall wellness through integration. - Through the use of clinical tools and information/data review (e.g., assessments, claims, etc.) conducts an evaluation of member’s needs and available benefits to collaborate and refer to programs offered by the plan sponsor. - Applies clinical judgment to reduce risk factors, address complex health issues and social indicators. - Utilizes case management processes in compliance with regulatory and company policies and procedures. - Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. - A private designated workspace free of distractions and high-speed internet Required Qualifications - Must have an active current and unrestricted RN license in state of residence. If located within the Nurse Licensure Compact jurisdiction, the ability to use their compact license without restriction - Must be willing and able to obtain additional state licenses as needed - 5+ years of acute care clinical experience as an RN (general medical, post-surgical, specialty including pediatrics, ICU, case management and discharge planning) - 1+ year(s) of experience utilizing computers and navigating multiple monitors while speaking with someone on the telephone - 1+ year(s) of experience with all Microsoft Office Suite applications - Must be willing and able to work Monday through Friday between the hours of 8:30am – 5:00pm in applicant's time zone for a scheduled 8-hour shift. Weekends and holidays may be required per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis - Must be willing and able to travel less than 5% for on-site meetings, trainings, or system updates, or to meet licensure requirements e.g., finger printing Preferred Qualifications - Compact RN licensure - 1+ year(s) of case management experience - Certified Case Manager (CCM) certification - Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues - Strong telephonic communication and organizational skills - Excellent critical thinking skills Education - Associate's Degree required - BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 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: 04/04/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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 Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This position’s responsibilities shall include, but are not limited to the following: - Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. - Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus. - Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate. - 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 facilitates including effective discharge planning. - Coordinates with providers and other parties to facilitate optimal care/treatment. - Identifies members at risk for poor outcomes and facilitates 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 Required Qualifications: - Active, current, and unrestricted Master's‑level Behavioral Health license in your state of residence, (e.g., LISW, LPC, or comparable) - OR - Registered Nurse licensure with psychiatric specialty, certification, or experience. - 1+ years of Utilization Review/Utilization Management experience required. - 3+ years of Behavioral Health clinical experience in a hospital setting. - Recent experience in an inpatient hospital behavioral health setting, or continuous, recent behavioral‑health‑focused work since that experience. - Ability to meet mandated decision turnaround times with limited schedule flexibility. Preferred Qualifications: - UM experience with members/children 0-21 Education: - Master’s degree in a Behavioral Health discipline - OR - Associate Degree in Nursing (ADN) with Behavioral Health experience - BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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: 04/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Role Description The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to navigate complex payer requirements, streamline the authorization process, and support seamless patient transitions. - Drives the authorization process—reviewing prospective, retrospective, and concurrent medical records. - Coordinates with referring hospitals to secure prior authorizations. - Partners with case management teams at ScionHealth facilities to complete concurrent review authorizations. - Acts as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors. - Safeguards revenue integrity, reduces delays, and supports the organization’s mission of delivering exceptional patient care. - Contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model. Qualifications - Strong relationship building skills and a spirit to serve to ensure effective communication and service excellence. - Knowledge of regulatory standards and compliance guidelines. - Working knowledge of medical necessity justification through non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs. - Working knowledge of Medicare, Medicaid and Managed Care payment and methodology. - Extensive knowledge of clinical symptomology, related treatments and hospital utilization management. - Excellent interpersonal, verbal and written skills to communicate effectively. - Critical thinking, problem solving, and decision-making capabilities. - Technical writing skills for appeal letters and reports. - Effective time management and prioritization skills. - Computer skills with working knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook). - Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members. - Must read, write, and speak fluent English. - Must have good and regular attendance. Requirements - Postsecondary non-Degree (Cert/Diploma/Program Grad) of an Accredited School of Nursing required. - Associate’s Degree in healthcare or related field required. - Bachelor’s Degree in healthcare or related field preferred. - Equivalent combination of Education and/or Experience in lieu of education (3+ years in a related field) may be considered. - Healthcare professional licensure preferred. - In lieu of licensure, 3+ years of experience in relevant field required. - Some states may require licensure or certification. - 3+ years of experience in a healthcare strongly preferred. - Experience in managed care, case management, utilization review, or discharge planning a plus. Benefits - Comprehensive benefits package for benefit-eligible employees. - Includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. Pay Range $66,700-$100,500/yr.

Anticipated End Date: 2026-03-23 Position Title: Medical Management Nurse Lead Job Description: Medical Management Nurse Lead 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 Lead in addition to the responsibilities of the Medical Management Nurse role, is responsible for serving as the team lead, coach, and technical resource for a team of either Medical Management Nurses or Medical Management Clinicians. Contributes on hiring, promotion, and other job-progression decisions for the nurses on their team. Works on special projects and helps to craft, implement, and improve organizational policies. Serves as the subject matter expert and department liaison to other areas of the business unit or as the representative on enterprise initiatives. How you will make an impact: - Identifies the need for, and driving the execution of, process or policy improvements. - Coordinates team members to ensure appropriate coverage. - Provides valuable recommendations in hiring decisions, as well as promotions. - Serves as a resource to lower-level nurses and clinicians. - Provides training for staff. - Improves materials used in orientation and training efforts. - Completes quality audits and helps to develop and implement associated corrective action plans. - Leads or participates on cross-functional teams, special projects, initiatives, and process improvement activities. - Assists team members, as appropriate, with review of the most challenging and complex cases, as well as overflow cases. - Works with healthcare providers to promote quality member outcomes, to optimize member benefits and promote effective use of resources. - Consults with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services. Minimum Requirements: - Requires a minimum of associate’s degree in nursing. - Requires a minimum of 6 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 Capabilities, Skills and Experiences: - Prior healthcare third party vendor (TPA) experience. - Leadership experience. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $85,956 to $128,934. 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.