• Provides counsel and advice to top management on significant Clinical Program Management matters • Focuses on providing thought leadership and technical expertise across multiple disciplines • Represents company externally and serves as conduit to educate and enable care coordination between stakeholders • Serves as clinical advisor to the sales organization, providing ongoing product and industry knowledge/education

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.