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. - Schedule: This is an Alternative Work Schedule weekend position. The role requires coverage of both Saturday and Sunday each week. Scheduling options may include four 10-hour shifts, five 8-hour shifts, three 12-hour shifts, or other approved configurations that meet operational needs. Specific schedules will be determined in collaboration with management to ensure adequate weekend coverage. Position Summary: Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members. Key Responsibilities: * Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations and recommendations along the continuum of care. * Communicate with providers and other parties to facilitate care and treatment. Identify members for referral opportunities to integrate with other products, services, or benefit programs. * Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization. * Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. * Meet set productivity and quality expectations as established by UMNC. Required Skills and Abilities: * Effective verbal and written communication skills. * Proficiency with computer skills, including navigating multiple systems and keyboarding. * Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. * Capacity to sit for extended periods, talk on the telephone, and type on the computer. Work Location: This is a work-from-home position. During work hours, colleagues must be available by phone, videoconference, and email as required by their leader. Occasional on-site attendance at the office or client location may be required for meetings, training sessions, or other events as directed. `Required Qualifications - Registered Nurse - Education: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience - Must have active current and unrestricted RN licensure in state of residence. - May be required to obtain additional Nursing Licenses as business needs require. * Preferred Qualifications - Utilization Management experience preferred Education Associates Degree 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: 03/27/2026 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. This RN Case Manager position is 100% remote and candidates can apply from any state but must work the stated hours. 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. RN Case Manager: – 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. 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 - Willingness and ability to obtain additional state licenses upon hire (paid for by the company) - 3+ years of acute care clinical experience as an RN (general medical, post-surgical, specialty including pediatrics, ICU, case management and discharge planning) - Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time - A private designated workspace free of distractions and high-speed internet - Must be willing and able to work Monday through Friday between the hours of 8:30-5pm EST for a scheduled 8-hour shift. - Must be willing and able to work Weekends and holidays per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. - Less than 5% travel may be required for on-site meetings, trainings, or system updates Preferred Qualifications: - Compact RN licensure - 1+ years 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. - Experience with all types of Microsoft Office including PowerPoint, Excel, and Word - Strong telephonic communication skills - 1+ years of experience utilizing computers and navigating multiple monitors while speaking with someone on the telephone. Education: Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 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: 03/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance Telephonic Case Manager PRIMARY PURPOSE OF THE ROLE: While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. - Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. - Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. - Enjoy flexibility and autonomy in your daily work, your location, and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. - Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. - Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. - Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. - Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs. ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Performs initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems. - Effectively communicates and builds relationships with the claims’ examiner, client, injured worker, attorney and supervisor. - Identifies issues related to delayed recovery and/or return to work and problem solves with a creative thinking approach - Negotiates treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality. - Identifies opportunities to expedite care for cost containment and timely medical recovery. - Provides recommendations for alternate clinical resources to support claim resolution. - Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards. EDUCATION AND LICENSING Current unrestricted RN license(s) in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, rehabilitation nursing or a related specialty is highly preferred. ​ TAKING CARE OF YOU BY - Offering a blended work environment. - Supporting meaningful work that promotes critical thinking and problem solving. - Providing on-going learning and professional growth opportunities. - Promoting a strong team environment and a culture of support. - Recognizing your successes and celebrating your achievements. - Thrives when everyone is working towards the same vision/goals. - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. #nurse #telephoniccasemanager As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $73,000 - $75,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always accepting applications. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

A Brief Overview Applies clinical expertise and knowledge of health care workflows in order to educate and train CDI Specialists in the essential duties of their role to improve the overall accuracy and comprehensiveness of medical record documentation, with focus on ensuring accurate reporting of quality outcomes Educates CDI Specialists on the rules/regulations associated with coding and clinical documentation integrity. Trains newly hired CDI Specialists and provides ongoing coaching and education specific to daily CDI Specialist job functions. Ensures the work output of the Clinical Documentation Integrity staff is accurate and compliant. Collaborates with CDI leadership and Coding team to identify training opportunities and assist with education of CDI and Coding staff with regard to clinical documentation integrity and/or clinical and coding scenarios as needed. What You Will Do - Performs post-discharge, final coded, pre-bill reviews of targeted records identified for second-level review for opportunity to accurately capture patient acuity, severity of illness, risk of mortality, and DRG assignment in compliance with industry rules and regulations • Documents SLR findings within CDI application. ◦ If a documentation opportunity is identified, place physician query and follow up for response to ensure completeness and accuracy of the medical record. ◦ If coding opportunity is identified, coordinate with coder and/or Coding Leadership to review and address opportunity as applicable - Serves as a role model and resource for CDI team members • Subject matter expert that exhibits excellent skills in essential components of the CDI Specialist role • Responds to CDS requests for concurrent chart reviews on challenging cases with recommendations and supporting rationale ◦ Performs concurrent second level reviews based on defined criteria and shares feedback with CDI Specialist assigned to the encounter for action on opportunities identified. - Maintains a summary of opportunities identified through second level review for feedback and education with the CDI team • Coordinates with other Second Level Reviewers, CDI Leads, and CDI Educator to compile trends and areas of opportunity and conduct education both 1:1 and group education with the CDI team based on the findings - Periodically review the criteria established for cases triggering a second level review and recommend updates or modifications to the criteria to assist in identifying areas of opportunity - Is actively engaged in quality and process improvement efforts • Performs targeted audits as assigned in support of department initiatives • Participates in quality initiatives such as HAC/PSI and US News/Mortality • Collaborates with CDI Leadership, Leads and Educators to optimize query templates • Identifies and shares feedback regarding workflow improvement opportunities identified when completing the SLR process • Facilitates change and supports the CDI team through change management processes • Actively engages in advancing the CDI practice throughout the UH enterprise • Actively engages in department and/or enterprise-wide committee Additional Responsibilities - Performs other duties as assigned. - Complies with all policies and standards. - For specific duties and responsibilities, refer to documentation provided by the department during orientation. - Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Education - Other Accredited Program: Diploma in Nursing or in Health Information Management (Required) or - Associate's Degree preferably in Health Information Management or Nursing (Required) or - Bachelor's Degree preferably in Health Information Management or Nursing (Required) or - Doctorate Degree in Medicine (Required) Work Experience - 3+ years CDI experience as a concurrent reviewer (Required) Knowledge, Skills, & Abilities - Extensive clinical knowledge and understanding of pathology/physiology; best demonstrated by clinical experience in hospital setting (Required proficiency) - Strong critical thinking skills and the ability to review the medical record to identify information not yet documented but supported by clinical indicators or clinical clues (Required proficiency) - Demonstrates comprehension of Case Mix Index (CMI) and can interpret, analyze, evaluate data, provide rationale for trends/impacting factors and develop strategy for correcting/optimizing CMI (Required proficiency) - Knowledge of age-specific patient needs and the elements of disease processes and related procedures (Required proficiency) - Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers (Required proficiency) - Assertive personality traits to facilitate ongoing physician communication (Required proficiency) - Working knowledge of inpatient admission criteria. (Required proficiency) - Ability to work independently in a time-oriented environment as well as working as part of a team, primarily in a virtual setting. (Required proficiency) - Applies knowledge and expertise to daily job responsibilities. Maintains professional knowledge by reading and/or attending webinars that pertain to Clinical Documentation Improvement. (Required proficiency) - Earns and maintains Certification for Clinical Documentation Improvement. (Required proficiency) - Incorporates current literature, research and best practice ( ACDIS and AHIMA ) into daily practice. (Required proficiency) - Up to-date clinical and coding experience, and current working knowledge of pathology, pharmacology, surgical procedures, etc. (Required proficiency) - Detail-oriented and organized, have excellent time-management skills, and have good analytical and problem-solving ability. (Required proficiency) - Notable client service, communication, presentation and relationship building skills. (Required proficiency) Licenses and Certifications - Registered Nurse (RN), Ohio and/or Multi State Compact License (Required Upon Hire) or - Registered Health Information Administration (RHIA) (Required Upon Hire) or - Registered Health Information Technologist (RHIT) (Required Upon Hire) and - Certified Clinical Documentation Specialist (CCDS) (Required Upon Hire) or - Clinical Documentation Improvement Practitioner (CDIP) (Required Upon Hire) - International medical doctor education and experience can meet qualifications in lieu of RN, RHIA or RHIT Physical Demands - Standing Occasionally - Walking Occasionally - Sitting Constantly - Lifting Rarely up to 20 lbs - Carrying Rarely up to 20 lbs - Pushing Rarely up to 20 lbs - Pulling Rarely up to 20 lbs - Climbing Rarely up to 20 lbs - Balancing Rarely - Stooping Rarely - Kneeling Rarely - Crouching Rarely - Crawling Rarely - Reaching Rarely - Handling Occasionally - Grasping Occasionally - Feeling Rarely - Talking Constantly - Hearing Constantly - Repetitive Motions Frequently - Eye/Hand/Foot Coordination Frequently Travel Requirements - 10%25