*** MSL is a must a long with RN license*** Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services. Essential Functions: - Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment - Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care - Engage with medical director when additional clinical expertise if needed - Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards - Identify and refer quality issues to Quality Improvement - Identify and refer appropriate members for Care Management - Provide guidance to non-clinical staff - Provide guidance and support to LPN clinical staff as appropriate - Attend medical advisement and State Hearing meetings, as requested - Assist Team Leader with special projects or research, as requested - Perform any other job related duties as requested. Education and Experience: - Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required - Three (3) years clinical experience required - Med/surgical, emergency acute clinical care or home health experience preferred - Utilization Management/Utilization Review experience preferred - Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: - Proficient data entry skills and ability to navigate clinical platforms successfully - Working knowledge of Microsoft Outlook, Word, and Excel - Effective oral and written communication skills - Ability to work independently and within a team environment - Attention to detail - Proper grammar usage and phone etiquette - Time management and prioritization skills - Customer service oriented - Decision making/problem solving skills - Strong organizational skills - Change resiliency Licensure and Certification: - Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required - MCG Certification or must be obtained within six (6) months of hire required Working Conditions: - General office environment; may be required to sit or stand for extended periods of time - Travel is not typically required Compensation Range: $62,700.00 - $100,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1

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 flexible, work‑from‑home role requires up to 75% travel for in‑home member visits in the following locations; Desoto, Hutchins, Redbird, Cockrell Hill, West Dallas, South Dallas, Parkdale, Bishop Arts, Oak Cliff, Pleasant Grove. Texas and follows a Monday–Friday, 8:00am–5:00pm CST schedule. The Case Manager delivers high‑quality, member‑centered care by conducting comprehensive in‑home assessments, developing individualized care plans, and coordinating services across physical, behavioral, and social needs for the pediatric demographic (0-21). Using advanced clinical judgment and strong critical‑thinking skills, the Case Manager collaborates with providers, interdisciplinary teams, and member support systems to ensure safe, cost‑effective care and optimal outcomes. Key responsibilities include facilitating access to Long‑Term Services and Supports (LTSS), advocating for members during care transitions, monitoring progress toward care goals, and documenting timely and accurately in the electronic health record. The role requires exceptional assessment, communication, and writing skills, along with the ability to motivate members, address barriers, and support informed decision‑making. Required Qualifications - Active and unrestricted RN license in the state of TX - 2+ years of clinical experience - Must reside in Desoto, Hutchins, Redbird, Cockrell Hill, West Dallas, South Dallas, Parkdale, Bishop Arts, Oak Cliff, Pleasant Grove, Texas - Must possess reliable transportation and be willing and able to travel up to 75% of the time in Desoto, Hutchins, Redbird, Cockrell Hill, West Dallas, South Dallas, Parkdale, Bishop Arts, Oak Cliff, Pleasant Grove, Texas - Mileage is reimbursed per our company expense reimbursement policy Preferred Qualifications Case Management and/or home health care experience Managed care organization (MCO) experience Pediatric experience 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: 04/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans is hiring a Authorization Coordinator/Licensed Practical Nurse (LPN) - Remote in Virginia Status: Full-time, permanent position (40 hours) Standard work hours: 8am to 5pm EST, M-F Location: Remote in Virginia Job Description Summary: - Responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment. Education: - HS - High School Grad or Equivalent REQUIRED; LPN Diploma or Associate Degree in Practical Nursing preferred Certification/Licensure: - Licensed Practical Nurse (LPN) - Nursing License - Compact/Multi-State License REQUIRED Experience: - Related experience- 3 years - Health Plan OR Utilization Management experience preferred - JIVA and Milliman Care Guidelines (MCG) experience preferred - Related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting, and prior authorization Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-96211 #Indeed Talroo – Health Plan Managed Care, MCO, Health Plan, Healthcare, Remote, Virginia, Virginia Beach, Clinical, LPN, License Practical Nurse, Utilization Management, Utilization Review, Medical Necessity, JIVA, Milliman Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free access to complete CEUs and professional development •Pet Insurance •Legal Resources Plan •Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

- Perform daily abstraction of cancer cases into the cancer registry database. - Responsible for running and resolving EDIT’s prior to submission of cases to the State Central Registry. - Utilize State Cancer Registry data standards and coding instructions to determine all reportable cases. - Abstract cases completely, whenever possible. In cases where complete treatment data is not available, request this information from the managing physician. - Abstract cases within six months from first date of first contact. - Maintain a log to document the abstraction of all records as well as non-reportable cases - Submit cases to the State Central Registry, if requested. - Process case finding, follow-up and other registry duties. - Maintain the suspense system, if required. Perform duties in compliance with Company’s policies and procedures, including but not limited to those related to HIPAA and compliance. - Maintains a knowledge base of ICD-O, AJCC Cancer Staging Manual, Hematopoietic and Lymphoid Database and Manual, SEER Coding and Staging Manual, Collaborative Staging, SEER Multiple Primaries and Histology’s, SEER Rx Database and Facility Oncology Data Standards - AAP/EEO Statement - Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com. - Founded in 2003, Omega Healthcare Management Services® (Omega Healthcare) empowers healthcare to thrive via intelligent solutions that optimize revenue cycle operations, administrative workflows, care coordination, and clinical research on a global scale. The company works with providers, payers, life science companies, medical device manufacturers, health technology firms, researchers, and industry partners to amplify teams with robust technology, specialty expertise, and operational support. Omega Healthcare serves more than 350 healthcare organizations with 35,000 skilled workers in the United States, India, Colombia, and the Philippines. For more information, visit www.omegahms.com AAP/EEO Statement Omega Healthcare is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, gender, age, sexual orientation, gender identity or expression, marital status, mental or physical disability, protected veteran status, and genetic information, or any other basis protected by applicable law. Omega Healthcare also prohibits harassment of applicants or employees based on any of these protected categories. Omega Healthcare makes reasonable accommodations when needed for applicants and candidates with disabilities or religious observances. If reasonable accommodation is needed to participate in the job application, interview, or any other part of the hiring process, please contact Human Resources at employeerelationsus@omegahms.com.