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 This is a remote work from home role anywhere in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. Key Responsibilities - This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. - Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. - Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. - Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. - 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 conversations. - Identifies and escalates member’s needs appropriately following set guidelines and protocols. - Need to actively reach out to members to collaborate/guide their care. - Perform medical necessity reviews. Required Qualifications - 5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting. - The AHH RN Case manager position requires the nurse to support members across multiple states. A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license. Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support. - 1+ years’ experience documenting electronically using a keyboard. - 1+ years’ current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience. Preferred Qualifications - 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. - 1+ years' experience in Utilization Review. - CCM and/or other URAC recognized accreditation preferred. - 1+ years’ experience with MCG, NCCN and/or Lexicomp. - Bilingual in Spanish preferred. Education - Diploma or Associates Degree in Nursing required. - BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $155,538.00 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. 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 This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Summary Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description Position Purpose: Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Logistics: PGBA - one of BlueCross BlueShield of South Carolina's subsidiary companies. Government Clearance: This position requires ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. What You'll Do: - May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination. Monitors process's timeliness in accordance with contractor standards. Performs authorization process, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines. - Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process. May conduct/perform high dollar forecasting research and formulate overall patient health summaries with future health prognosis and projected medical costs. Performs screenings/assessments and determines risk via telephone. - Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services. Provides education to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination and basis for each. Conducts research necessary to make thorough/accurate basis for each determination made. - Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations. - Participates in quality control activities in support of the corporate and team-based objectives. Participates in all Required Licenses and Certificates. To Qualify For This Position, You'll need the - Required Education: Bachelor's degree - Social Work, OR, Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. - Required Experience: 2 years clinical experience. - Required Skills and Abilities: Working knowledge of word processing software. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to remain in a stationary position and operate a computer. - Required Software and Tools: Microsoft Office - Required Licenses and Certificates: Active, unrestricted LPN/LVN licensure from the United States and in the state of hired, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LBSW (Licensed Bachelor of Social Work) licensure from the United States and in the state of hire. We Prefer that You have the Following: - Preferred Education: Associate Degree- Nursing OR Graduate of an Accredited School of Nursing. - Preferred Skills and Abilities: Working knowledge of spreadsheet and database software. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. - Preferred Software and Others Tools: Knowledge of Microsoft Excel, Access, or other spreadsheet/database software. - Preferred Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Our Comprehensive Benefits Package Includes The following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized Health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do For You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.

Overview: We seek a Patient Education Liaison (PEL) to support AMVUTTRA® (vutrisiran). The U.S. Food and Drug Administration (FDA) recently approved the supplemental New Drug Application (sNDA) for AMVUTTRA® (vutrisiran). The approval expands the indication for AMVUTTRA, which now becomes the first and only therapeutic approved by the FDA for the treatment of ATTR-CM and the polyneuropathy of hereditary transthyretin-mediated amyloidosis (hATTR-PN) in adults. The PEL is a critical component of the product brand commercial strategy and works in close coordination with Field Sales, Field Reimbursement, Patient Services, Advocacy, and Marketing teams to support Alnylam’s patient-focused vision of harnessing a revolution in biology for human health. The Patient Education Liaison is responsible for educating patients, caregivers, families, nurses, medical assistants, office staff, professional nursing organizations, and pertinent community groups on disease state and Alnylam’s RNAi treatments for all Alnylam brands. Using approved materials, the Patient Education Liaison will educate on the disease state, Alnylam treatments, and Alnylam’s services, through phone-based, in-person, and virtual meetings. Central to this role is the ability to work with regional, field-based and internal colleagues to identify barriers to patient access and work to resolve them. The successful candidate must be passionate about science and deeply motivated by the quest of delivering education to patients and their families with the long-term success of the company in mind. The ideal candidate will be a self-motivated, self-starter with an innovative, entrepreneurial spirit. Key Responsibilities: - Actively collaborates with Field Sales, Patient Services, Medical Affairs, Marketing, Advocacy and other critical internal teams to increase disease-state awareness and early diagnosis - Leads regional effort to provide disease-state education, treatment education and support to patients their families/caregivers, nurses, medical assistants, office staff, nursing organizations, and community groups - Maintains disease-state and product expertise through continuing medical education and attendance at relevant symposia, conferences and other educational opportunities - Provides comprehensive updates on activity to PEL Lead and regional colleagues, ensuring that the regional team appropriately works as one entity to support patients in early diagnosis and access to treatment - Accountable for executing on targeted workplan - Completes required work in CRM system to facilitate tracking of critical launch metrics - Ensures compliance with all corporate and industry policies with training provided by Alnylam Commercial, Legal, Regulatory and Compliance Officers Qualifications: - Bachelor of Science in Nursing, Registered Nurse (required) - 2+ yrs. Pharmaceutical/biotech experience in a similar role - Experience supporting and providing education to patients, family members, nurses, medical assistants, office staff, nursing organizations, and community groups - Strong presentation skills - Cardiology experience preferred - Exceptional interpersonal skills, professional communications, problem-solving, compassion and the ability to navigate difficult conversations - Ability to translate scientific/medical information into patient-friendly language - Ability to work well and lead within cross-functional groups and in a matrix organization - Desire to innovate and work in a fast-paced, energetic environment - Self-starter who is highly passionate about Alnylam’s core values: Commitment to People, Fiercely Innovative, Open Culture, Passion for Excellence, and Purposeful Urgency. - This position requires frequent travel within the region and at times nationally. Includes overnight travel and weekends. - Must be able to travel up to 75% - Valid Driver’s License #LI-ST1 #LI-Remote U.S. Pay Range $136,000.00 - $184,000.00 The pay range reflects the full-time base salary range we expect to pay for this role at the time of posting. Base pay will be determined based on a number of factors including, but not limited to, relevant experience, skills, and education. This role is eligible for an annual short-term incentive award (e.g., bonus or sales incentive) and an annual long-term incentive award (e.g., equity). Alnylam’s robust Total Rewards package is designed to support your overall health and well-being. We offer comprehensive benefits including medical, dental, and vision coverage, life and disability insurance, a lifestyle reimbursement program, flexible spending and health savings accounts and a 401(k)with a generous company match. Eligible employees enjoy paid time off, wellness days, holidays, and two company-wide recharge breaks. We also offer generous family resources and leave. Our commitment to your well-being reflects our belief that caring for our people fuels the impact we create together. Learn more about these and additional benefits offered by Alnylam by visiting the Benefits section of the Careers website: https://www.alnylam.com/careers About Alnylam We are the leader in RNAi therapeutics – a revolutionary approach with the potential to transform the lives of people with rare and common diseases. Built on Nobel Prize-winning science, Alnylam has delivered the breakthroughs that made RNAi therapeutics possible and are just at the beginning of what’s possible. Our deep pipeline, late-stage programs, and bold vision reflect our core values: fierce innovation, passion for excellence, purposeful urgency, open culture and commitment to people. We're proud to be a globally recognized top employer, where an authentic, inclusive culture and breakthrough thinking fuel one another. At Alnylam, we commit to an inclusive recruitment process and equal employment opportunity. Qualified applicants will receive consideration for employment without regard to their sex, gender or gender identity, sexual orientation, race, color, ethnicity, national origin, ancestry, citizenship, religion, creed, physical or mental disability, pregnancy status or related conditions, genetic information, veteran or military status, marital or familial status, political affiliation, age, or any other factor protected by federal, state, or local law. Alnylam is an E-Verify Employer.

Job Description Summary #LI-Remote-Nashville (KY/TN/WV) Location: Remote- This position focuses on disease states (e.g. prostate cancer, neuroendocrine tumors, & etc.) being treated by Novartis’ Radioligand Therapies. The Medical Science Liaison (MSL) role is a field based, customer-facing, non-promotional medical and scientific position. The MSL’s key objective is to create impact through advancing clinical practice within the assigned territory that leads to improved patient outcomes. The MSL must demonstrate deep therapeutic expertise, understand territory and market influences, engage scientifically with Healthcare Providers (HCPs) and medical experts, manage, and develop their territory and execute all relevant activities in alignment with the medical strategic and tactical plan – while functioning within the Novartis Code of Conduct, Ethics/Compliance policies and Working Practice documents. The MSL will Inform and shape medical strategy through application of a curious mindset to collect impactful and actionable insights, understanding the potential strategic impact of critical insights. This territory will be responsible for covering KY, TN, and WV. The preferable location for the successful candidate to reside would be in greater Nashville, TN area. Must live within 50 miles of the border of this territory to be considered. Relocation is not available. Role Responsibilities include, but are not limited to • The MSL will leverage scientific expertise and market knowledge to establish and build professional relationships and engage with HCPs (including community physicians, pharmacists, medical experts, nurses, and other healthcare professionals) and other thought leaders in geographical area as aligned with medical strategy. • The primary responsibility of the MSL is to engage with customers - customer engagements may include but are not limited to: emerging data discussions, clinical trial activities, uncovering barriers in patient journey, understanding market dynamics within their territory, exploration of areas of unmet medical need, pipeline discussions, educating on disease state and product, capturing adverse events, and capturing medical insights through all stages of product lifecycle. • Must demonstrate strategic territory vision and ensure appropriate territory identification, mapping, and planning of Medical Engagements (MEs) and Key Accounts as aligned to medical strategy and in collaboration with internal Novartis colleagues. This includes: a. identification of key stakeholders with influence on the patient journey and in the disease space throughout the product development lifecycle to establish strategies for education, engagement, and partnership b. identification of opportunities for partnership with academic centers, centers of excellence, and/or systems of care to drive impact within the assigned territory c. identification of opportunities to involve HCPs or MEs when a specific medical need is identified (e.g., publications, clinical trial participation, etc.) d. identification of opportunities for internal collaboration with other Novartis stakeholders to drive forward therapeutic area, clinical, or product goals as appropriate• Provide clinical trial support for company sponsored trials facilitating relevant medical activities and working cross-functionally with Medical Affairs and Clinical Operations colleagues. • Regularly and effectively collaborates with internal colleagues (e.g., HEOR, access, marketing, commercial, sales) within the assigned therapeutic area and territory to advance clinical practice while maintaining customer centricity and a One Novartis approach in accordance with Novartis compliance standards. • Maintain in-depth knowledge of assigned therapeutic area and Novartis compounds to serve as a medical resource to customers and internal colleagues (in accordance with Working Practice Documents). • Maintain in-depth knowledge of internal policies and external regulations (e.g., field medical Working Practice Document (WPD), travel policy, expense policy, state and local laws, institutional policies) and how they affect day-to-day responsibilities. • Execute all administrative responsibilities and training (e.g., Veeva CRM, voicemail, e-mail, expense reports, compliance modules, etc.) in a timely manner, including profiling of core customers and ensuring up-to-date information in the CRM. • Champion emerging responsibilities as strategic priorities and territory needs evolve • Proactively drive personal and professional development. Job Description MSL, Manager - level: Education: Graduate degree in science or healthcare required; doctoral degree preferred (MD, PhD or PharmD) Experience: • 0-3 years of experience in a Field Medical position within the pharmaceutical industry or as an MSL is required OR • 3-5 years of relevant medical affairs, clinical research, or related experience in a scientific or clinical setting preferred. Previous experience in assigned or related therapeutic area is preferred. • Strong clinical knowledge including pharmacotherapy, treatment guidelines, clinical research processes, medical expert engagement strategies, and FDA promotional guidelines, regulations, and ethical guidelines applied to the pharmaceutical industry is required. MSL, Associate Director - level: Education: Graduate degree in science or healthcare required; doctoral degree preferred (MD, PhD or PharmD) Experience: • Minimum of 3 years’ experience in a Field Medical-based position within the pharmaceutical industry or as an MSL is preferred OR • 5-7 years of relevant medical affairs, clinical research, or related experience in a scientific or clinical setting required. Previous experience in assigned or related therapeutic area is preferred. • Strong clinical knowledge including pharmacotherapy, treatment guidelines, clinical research processes, medical expert engagement strategies, and FDA promotional guidelines, regulations, and ethical guidelines applied to the pharmaceutical industry is required. Travel: • Field based, customer-facing position majority of the time with approximately 60-70% travel required to achieve performance and business objectives (face to face, virtual, email, telephone, etc.). Must have a valid driver’s license. • Field-Based (Region: covering KY, TN and WV). Candidate must reside within territory, or within a reasonable daily commuting distance of 50 miles from territory border. • The expectation of working hours and travel (domestic and/or international) will be defined by the hiring manager NOTE: Above level experience criteria are not an exhaustive list Field roles with a dedicated training period only: The individual hired for this role will be required to successfully complete certain initial training, including home study, in eight (8) or fewer hours per day and forty (40) or fewer hours per week. Field roles with a company car: Driving is an essential function of this role, meaning it is fundamental to the purpose of this job and cannot be eliminated. Because driving is an essential function of the role, you must have a fully valid and unrestricted driver’s license to be qualified for this role. The company provides reasonable accommodations for otherwise qualified individuals with medical restrictions, if an accommodation can be provided without eliminating the essential function of driving. The pay range for this position at commencement of employment is expected to be between; for Manager: $145,600 - $270,400 and for AD: $160,300 - $297,700 year. The final salary offered is determined based on factors like, but not limited to, relevant skills and experience, and upon joining Novartis will be reviewed periodically. Novartis may change the published salary range based on company and market factors. Your compensation will include a performance-based cash incentive and, depending on the level of the role, eligibility to be considered for annual equity awards. US-based eligible employees will receive a comprehensive benefits package that includes health, life and disability benefits, a 401(k) with company contribution and match, and a variety of other benefits. In addition, employees are eligible for a generous time off package including vacation, personal days, holidays and other leaves. Why Novartis: Our purpose is to reimagine medicine to improve and extend people’s lives and our vision is to become the most valued and trusted medicines company in the world. How can we achieve this? With our people. It is our associates that drive us each day to reach our ambitions. To learn more about the culture, rewards and benefits we offer our people click here. EEO Statement: The Novartis Group of Companies are Equal Opportunity Employers. We do not discriminate in recruitment, hiring, training, promotion or other employment practices for reasons of race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, marital or veteran status, disability, or any other legally protected status. Accessibility and reasonable accommodations The Novartis Group of Companies are committed to working with and providing reasonable accommodation to individuals with disabilities. If, because of a medical condition or disability, you need a reasonable accommodation for any part of the application process, or to perform the essential functions of a position, please send an e-mail to us.reasonableaccommodations@novartis.com or call +1(877)395-2339 and let us know the nature of your request and your contact information. Please include the job requisition number in your message. Salary Range $160,300.00 - $297,700.00 Skills Desired Building Construction, Business Analysis, Business Networking, Clinical Practices, Clinical Research, Clinical Study Reports, Collaboration, Curious Mindset, Disease Management, Diversity & Inclusion, Drug Development, Epidemiology, Medical Information, Medical Research, Medical Writing, Microsoft Word, Phase Iv Clinical Trial, Product Placement, Scientific Support