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 Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985. We provide access to physical and behavioral health care services, to people who are eligible for Medicaid. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple contracts with AHCCCS, Arizona’s Medicaid agency, and deliver services throughout the state. Mercy Care is administered by Aetna, a CVS Health company. Our staff is employed by Aetna and CVS Health. This gives Mercy Care the resources of a national organization, and still allows us to bring our members the familiarity and presence of a local team of people who put our members at the center of everything we do. This position involves: - Prior authorization review of physical and behavioral health related services. - Utilization of clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. - Application of critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for members with disabilities and special healthcare needs. - Taking provider calls related to prior authorization questions and making calls to members to inform of the coverage determination. - Gathering clinical information and applying appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment, in order to render coverage determination/recommendation/discharge planning along the continuum of care. - Utilization of clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members. - Identification of members who may benefit from care management programs and facilitation of the referral. - Identification of opportunities to promote quality effectiveness of healthcare services and benefit utilization. - Sedentary work involving periods of sitting, talking, and listening. - Performing other duties as assigned. Required Qualifications - 5+ years of clinical experience as RN (Registered Nurse). - Ability to work 8-hour shifts, 5-days per week, with rotating days (including some weekends & holidays), supporting Arizona Time Zone. - Must have an active and unrestricted RN licensure in the state of Arizona or Compact RN licensure. Preferred Qualifications - Previous experience in utilization management. - Previous experience in both medical and behavioral health fields. - Previous experience in acute care. - Strong critical thinking and written communication skills. - Ability to operate independently. Education - Associate’s degree in Nursing. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $74.78 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 04/15/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• Perform medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. • Document decisions using indicated protocol sets or clinical guidelines. • Provide support and review of medical claims and utilization practices. • Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. • Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. • Monitors process’s timeliness in accordance with contractor standards. • Documents medical rationale to justify payment or denial of services and/or supplies. • Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. • Participates in quality control activities in support of the corporate and team-based objectives. • Provides guidance, direction, and input as needed to LPN team members. • Provides education to non-medical staff through discussions, team meetings, classroom participation, and feedback. • Assists with special projects and specialty duties/responsibilities as assigned by management.

We are currently recruiting for a Estimate Reviewer to join our team remotely in Canada. The position location is flexible, and we can offer in-office, hybrid or fully remote working arrangements. The successful applicant will be required to review the estimates of the network contractors, ensure the technical accuracy of the bid, ensure that program guidelines are followed, and ensure that industry standards are followed. Performing quality checking of file documentation, proper use of estimating software and pricing as well as proposed estimating of repairs meets customer standards and requirements. Reviews additional repair specifications received and completes the secondary review process for technical accuracy and adherence to industry standards. The candidate will also be responsible for communication between contractors, the regional manager and with claims adjusters The salary range is $54,000 to $67,000 annually

Title: Medical Biller & Credentialing Specialist Location: Glen Rock, NJ Department: Billing Job Description: SportsMed Physical Therapy is seeking a Medical Biller/Credentialing Specialist to join our team. This position will begin training on site full-time in either Glen Rock, NJ or Franklin Lakes, NJ and will transition to Hybrid-Remote after 2-3 months at the discretion of the billing manager. Candidates for this role must be local to the New Jersey area. This is a dual-role that combines medical billing/AR with oversight of the provider credentialing process SportsMed is one of New Jersey’s leading providers of physical rehabilitation services. We can offer you a fast paced and challenging career opportunity. If you are passionate about healthcare, motivated and want to make a difference, SportsMed is the place for you. Responsibilities Credentialing Responsibilities - Oversee the credentialing and recredentialing process for providers and ensure completion in a timely manner - Maintain provider credentialing database - Communicate with providers to collect documentation and complete necessary credentialing steps - Communicate with insurance networks to coordinate provider enrollment - Monitor credentialing timelines and keep track of necessary recredentialing steps - Stay informed of industry regulations and credentialing requirements - Must have knowledge of Pecos, NPPES, and CAQH Billing Responsibilities - Review new patient records in billing software and initiate billing process - Work with clinic staff to resolve patient authorization issues - Review existing claims in billing software and follow up on outstanding issues - Review outdated claims in billing software to research and resolve as necessary - Review outdated claims in billing software and prepare for collection as necessary - Work with insurance companies to resolve billing issues - Work with patients to resolve billing and collection issues - Ensure all billing changes, charge offs, escalations, interactions etc. are correctly documented in billing and/or HRM software in a timely manner - Properly escalate billing issues where necessary - Follow company processes and procedures carefully - Prepare and update summary documentation as required - Other duties as assigned by management Qualifications - Minimum 4 years’ experience with medical billing required and minimum 2 years' experience with provider credentialing process required - Solid understanding of medical billing software and procedures preferred (Kareo, WebPT, Navinet, CMD, etc.) - Knowledge and understanding of Pecos, NPPES, and CAQH - Ability to multitask and manage time effectively with minimum supervision - Excellent written and verbal communication skills - Strong basic Excel skills - Outstanding problem-solving and organizational abilities - Keen attention to detail with strong analytical skills - A professional, courteous, enthusiastic, and conscientious attitude, willing to fulfill group goals and work requirements - Ability to deal positively with coworkers and supervisors, and support management decisions - Ability to function as a contributing team member while meeting deadlines and productivity standards - Out-of-network and in-network billing experience Benefits - Competitive pay based on experience - Medical, Dental, Vision insurance options - Life and disability insurance options - PTO, sick time, paid holidays. 401k - Excellent career growth opportunities - Pay Rate $22.00 - $26.00 per hour $22 - $26 an hour