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. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): -Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. -Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. -Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. -Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members -Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, 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 -Communicates with providers and other parties to facilitate care/treatment -Identifies members for 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: -Must have current unrestricted RN licensure in their state of residence -2+ years clinical practice experience as an RN required -1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications -Must be willing to travel to the local office as needed. Preferred Qualifications: - It is preferred that the candidate live within driving distance of San Antonio, TX -Bilingual in Spanish and English -Strong computer skills Education: -Associates Degree in Nursing is minimum required, 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: 04/04/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Company Description Chamberlain University has a 130-year history and the mission to educate, empower, and embolden diverse healthcare professionals who advance the health of people, families, communities, and nations. We’re 99,000 strong, with 31,000 students and 68,000 alumni armed with the skills, passion, and determination to make a difference in today’s complex healthcare environment. By living Chamberlain Care®, we’ve built a culture in which colleagues and students thrive and we graduate extraordinary healthcare professionals who transform the health of people worldwide. Our regionally accredited University is comprised of the College of Nursing and the College of Health Professions. Our College of Nursing offers a Bachelor of Science in Nursing (BSN) degree program at 23 campuses and online post-licensure degree programs and certificates including RN to BSN, RN to MSN, a Master of Science in Nursing (MSN) with six Specialty Tracks, and a Doctor of Nursing Practice (DNP). Our College of Health Professions offers online options with a Master of Public Health degree, Public Health Certificate programs, and a Master of Social Work degree. Learn more about Chamberlain University, part of Adtalem Global Education, at www.chamberlain.edu. Job Description Chamberlain University College of Nursing is seeking Online Faculty (part-time) for our Master of Science in Nursing Psychiatric Mental Health Nurse Practitioner (MSN PMHNP) Program. We build long-term relationships with superior educators who are experts in their field and committed to providing the finest in practitioner-focused education. We are presently accepting applications to meet future need from qualified candidates with interest in teaching a variety of courses. Courses of instruction include but are not limited to: NR547 - Differential Diagnosis in Psychiatric-Mental Health Across the Lifespan Practicum - This course will provide students with the fundamental knowledge needed to formulate a differential diagnosis of individuals within the with psychiatric mental health setting. The Diagnostic and Statistical Manual of Mental Disorders will be introduced, providing the foundation for critical diagnostic skills to cultivate evidence-based behaviors. An emphasis will be placed on processing client information in a logical, progressive manner and formulating differential diagnoses for individuals across the lifespan. The course will include 125 hours of supervised clinical practicum. NR548 - Psychiatric Assessment for Psychiatric-Mental Health Nurse Practitioner - This course expands the knowledge and skills of health assessment principles to perform a thorough psychiatric mental health assessment. The Standards of Psychiatric Mental Health Nursing Practice Advanced Practice Competencies will be introduced. The psychiatric interview will be explored, including interview techniques. Students will develop assessment techniques related to psychiatric history and the review of systems for mental health clients across the lifespan. NR605 - Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum - This course will incorporate psychosocial theories and psychotherapy modalities within mental health. Individual and group therapies will be explored as a foundation for non-pharmacological and adjunct treatment of psychiatric mental health disorders across the lifespan. The therapeutic alliance and use of self will be examined. Students will further develop their skills related to health promotion, prevention of illness, diagnosis, and management of acute and chronic mental health problems. Care strategies will include psychotherapy, psychopharmacological prescribing, patient education, follow-up, and referral through a practicum experience in a precepted psychiatric mental health setting. NR606 - Diagnosis & Management in Psychiatric-Mental Health II Practicum - In this course the student expands knowledge in the care of patients specific to the role of the PMHNP, with a focus on perinatal, child and adolescent populations. Students will further develop their skills related to health promotion, prevention of illness, diagnosis, and management of acute and chronic mental health problems. Care strategies will include psychopharmacological prescribing, psychotherapy, patient education, follow-up, and referral through a practicum experience in a precepted psychiatric mental health setting. NR607 - Diagnosis & Management in Psychiatric-Mental Health III Practicum - In this course the student will expand upon previous knowledge to include complex mental health diagnoses and psychiatric emergencies. Students will further develop their skills related to health promotion, prevention of illness, diagnosis, and management of complex psychiatric mental health problems across the lifespan. Care strategies will include psychopharmacological prescribing, psychotherapy, patient education, follow-up, and referral through a practicum experience in a precepted psychiatric mental health care setting. NR668 - Psychiatric-Mental Health Capstone Practicum & Intensive - The student will synthesize all elements of clinical management skills and knowledge and continue to analyze, apply, and evaluate diverse aspects of patient assessment and healthcare intervention. This precepted clinical practicum will be with an approved provider in psychiatric mental health setting. Focus topics include clinical management skills, case studies, chart reviews, and practice critique, with a capstone product evidencing increasing complex psychiatric mental health clinical management skills. At the end of this course the student will be prepared for entry into clinical practice providing psychiatric mental healthcare across the lifespan after first passing the national certification for the psychiatric mental health nurse practitioner. If you are passionate about nursing and advancing your career through the power of education, we invite you to step forward and apply today! In this role, you will: - Inspire students to complete their programs by providing regular, meaningful feedback about their academic performance, development and participation while encouraging them to engage fully in their education. - Engage students in meaningful asynchronous threaded discussions at least 4 days per week, moderating participation, evaluating responses and rationales, and responding to questions or comments. - Evaluate academic progress and comprehension of course content through assigning and grading quizzes, exams and writing assignments. - Exhibit Chamberlain Care ™ by displaying behaviors of care, respect and professionalism, creating a culture that fosters collaboration, cooperation and respect among all. - Be readily available to meet the needs of a student body that is diverse in age, culture and academic preparation. - Identify and embrace opportunities to enhance student engagement by reaching out to students in need and responding quickly to requests for help. - Bring your professional experience to life through professional development, introducing industry perspective into courses and sharing information about nursing trends and opportunities with students. - Promote student success by demonstrating flexibility in style, schedule, and exhibiting your passion for teaching by devoting time and energy to improve scholarly excellence and subject matter expertise. - Foster a positive learning environment by maintaining accurate records, submitting grades on time, and enforcing academic policies. - Use appropriate technological options for online technologies and course-related software, including Websites, e-mail, and online discussions for preparing the course and making it accessible to students. - Model effective oral and written communications that engage the students, provide clarity, and improve student learning. - Set clear expectations for the course by publishing course terminal objectives, assignment/examinations dates, and weight the distribution of various evaluation categories. - Ensure that the content and level of material included on exams correspond to the course terminal objectives. - Be available via email or telephone to provide support to the student. - Introduce problem based learning presentations in which students are introduced to basic health assessment methods and tools. - Facilitate discussions by asking questions, asking for rationale, and encouraging students to employ critical thinking skills as they encounter increasingly complex issues. - Evaluate student progress in the effective use of critical thinking skills and the application of proficiencies developed in the program through practice exams. - Communicate with students at least four times weekly throughout the 8-week course and respond to any student inquiries in a timely manner. - We invite you to read our FAQ's about teaching for Chamberlain online for more details Qualifications You are encouraged to explore this opportunity if you meet these requirements: - MSN and DNP (or MSN and PhD in nursing) degrees are required - At least 1 year of practice experience directly in psychiatric mental health nursing is required - Online Teaching experience is preferred (preferably at the graduate level) - Must have active unencumbered RN nursing license; compact/multi-state licensure required - Must have Illinois RN license or be willing to obtain prior to orientation start date - PMHNP National Certification required - Must have subject matter expertise in the course of instruction - Faculty must have excellent communication, motivational, and instructional skills in a diverse and non-traditional environment - Proficient in using MS Office (Word, Outlook, Excel, PowerPoint), WebEx/Teams (or similar platform) and Internet Thank you for applying for this outstanding opportunity today! Additional Information Chamberlain Visiting Professor Position - Online: In support of the pay transparency laws enacted across the country, the expected compensation rate for this position is between $715/Earned Credit Hour to $1,950/Earned Credit Hour, depending on the candidate’s education and experience. Actual pay may be adjusted based on job-related factors permitted by law, such as type of course taught; experience and training; geographic location; licensure and certifications; market factors; departmental budgets; and responsibility. Our Talent Acquisition Team will be happy to answer any questions you may have, and we look forward to learning more about your salary requirements. Equal Opportunity – Minority / Female / Disability / V / Gender Identity / Sexual Orientation - Department: Faculty

Role Description This post holder will have responsibility for leading and the continued development of a Peninsula wide Cancer Academy on behalf of the Peninsula Cancer Alliance. With a requirement to support development and implement of a pan-trust Cancer Education strategy. The programme will require innovation, transformation and strong leadership from the Academy Lead. The post holder will work closely with the Workforce Lead, Lead Cancer Nurses and Cancer leads in each Trust to form collaborative relationships with Stakeholders across the Peninsula Integrated Care System, Provider Trusts, Arm’s-Length Bodies (ALBs), Education Providers and other key partners to drive the delivery of the strategy across the system, ensuring the delivery of the agreed outcomes within agreed timescales. - Development of a Peninsula Cancer Education Strategy and implementation plan - Lead the education programme on behalf of the Peninsula Cancer Alliance through delegated leadership and working collaboratively - Support the Alliance Workforce Lead on the development of a cancer workforce strategy across the Peninsula - Work collaboratively with the Alliance ACCEND implementation lead to ensure training and education is aligned to the ACCEND framework - Facilitate the Cancer Academy Steering Group and subgroups to ensure deliverables are met within specific timeframes - Continue strong links with key partners including Higher Education Institutions (HEIs), Health Education England (HEE), Integrated Care System (ICS), Cancer Research UK (CRUK), Macmillan, etc., to identify collaboration opportunities across the Peninsula - Lead communications and engagement plan for regional and national training and education Qualifications - Recent relevant experience as dictated by the Person Specification Requirements - Be flexible and adaptable to the needs of the service supporting colleagues and external providers - Work alongside partner organisations and agencies to co-deliver education where required and promote partnership working - Work closely with internal and external teams, stakeholders and organisations to lead, advise, support, facilitate, monitor and performance manage the implementation of the programme - Lead projects on behalf of the Workforce Lead utilising subject matter expertise - Build and preserve trusted stakeholder relationships and networks of influence among external, senior stakeholders in challenging circumstances - Communicate, provide and present highly complex information to a wide range of internal and external stakeholders - Provide and receive contentious or sensitive information from a range of senior stakeholders - Build consensus amongst varied and challenging stakeholder groups Benefits - Opportunities for career development in a highly progressive working environment - Support for work-life balance, including requests for less than full-time/flexible working - Commitment to diversity and inclusion in the workplace Company Description We are a people business – where every member of staff matters and can make a difference. Patients are at the heart of everything we do. Joining University Hospitals Plymouth NHS Trust means becoming part of a team of dedicated staff, who are committed to leading the way through innovation, clinical excellence and great customer care.

American Specialty Health Incorporated is seeking a Manager I - CQE Acupuncture to join our Clinical Quality Evaluation (CQE) department. This position will render medical necessity review determinations of services requested by Acupuncture practitioners. Salary Range American Specialty Health complies with state and federal wage and hour laws and compensation depends upon candidate’s qualifications, education, skill set, years of experience, and internal equity. $69,200 to $85,000 Full-Time Annual Salary Range. Remote Worker Considerations: Candidates who are selected for this position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This remote/WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum internet download of 50 Mbps and 10 Mbps upload speed. 100 down/20 up is recommended to support higher quality video meetings). Responsibilities - Manages the medical necessity review of acupuncture services. - Performs medical necessity review of requested services from network and non-network Acupuncture practitioners. - Conducts timely, accurate, and inter- and intra-consistent reviews in order to verify and approve medically/clinically necessary and appropriate care and services for our health plan members. - Effectively communicates rationale for clinical decision making to peers using evidence/outcomes-based principles and professional experience. - Supports clinical credentialing and medical records review of Network Practitioners, as needed. - Provides clinical investigation of credentialing, MNR, and quality-of-care issues for presentations to committees, as requested. - Reviews files in regulatory, accreditation, health plan, and medical group audits as required. - Conducts outreach calls as assigned. - Participates in Clinical Quality Administration and Clinical Quality Evaluation workgroups. - Promotes a productive team environment. - Participates in clinical article review activities as assigned. - Provides interdepartmental support to Medical Necessity Administration department, as necessary, for performance of assigned tasks. - Works independently, receiving minimal guidance and supervision. - Collaborates with senior management and various departments regarding clinical programs, policies, and protocol development and implementation. - Researches and develops clinical content, policies, and protocols in support of the Health Services and other associated departments, as necessary. Qualifications - Professional degree in Acupuncture from accredited college or university required. Additional post-graduate degree in same or related field a plus. - A current, unrestricted license to practice in his/her health care specialty in California. Employee must maintain a current, unrestricted license to practice in California and must be in good standing with all judicial and governing bodies. While most states only require licensure in a state in the United States, some states may require state-specific licensure. Employee must be willing and able to obtain other state licenses if needed for job functions. (Required). - Minimum of 5 years of clinical experience. Specific experience with medical necessity case review preferred. - Understanding of Acupuncture practice guidelines and best practices required. - Working knowledge of managed Acupuncture services is a plus. - Fluency in Chinese or Korean languages a plus. - Advanced training or certification in any specialty areas of Acupuncture, health care or quality management, case management, performance improvement, data analysis, and quality initiatives a plus. - Must meet ASH clinical credentialing requirements. - Ability to independently resolve problems or issues related to clinical determinations using good judgment or to escalate problems or issues to supervisor(s), as appropriate. - Use of computer systems in business application including, but not limited to: 10-key, Outlook, MS-WORD, IHIS, ASHCore, SharePoint and Microsoft Teams required. - Ability and willingness to serve as a peer-clinician resource to assist practitioners to interact more effectively and efficiently within ASH programs and systems. - Provides critical evaluation of submitted clinical documentation in order to make medical necessity determinations with the scope of accountabilities. - Provides clinical decision-making in support of credentialing, quality improvement, quality assurance, and medical necessity verification activities. - Must possess the ability to apply and communicate evidence-based criteria and approved guidelines to specific medical necessity review scenarios and describe clinical rationale consistently and effectively and in a professional manner. Core Competencies - Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships. - Ability to display excellent customer service to meet the needs and expectations of both internal and external customers. - Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment. - Ability to effectively organize, prioritize, multi-task, and manage time. - Demonstrated accuracy and productivity in a changing environment with constant interruptions. - Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions. - Ability to exercise strict confidentiality in all matters. Mobility Primarily sedentary, able to sit for long periods of time, able to travel by automobile and air. Physical Requirements Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs. Environmental Conditions Work-from-home (WFH) environment. American Specialty Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law. Please view Equal Employment Opportunity Posters provided by OFCCP here. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702. ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information. #LI-Remote #Healthcare #Clinic #Acupuncture #Therepist