We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, 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 Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. <ul><li> 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. </li><li> 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</li><li> Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs </li><li> Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization </li><li> Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li><li> Typical office working environment with productivity and quality expectations. </li><li> Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. </li><li> Sedentary work involving periods of sitting, talking, listening. </li><li> Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. </li><li> Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. </li><li> Effective communication skills, both verbal and written </li></ul> Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in ET, CT zones Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $32.01 - $68.55 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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Utilization Management Nurse Consultant

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, 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 <ul><li> 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. </li><li> 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. </li><li> Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization. </li><li> Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li><li> Meet set productivity and quality expectations as established by UMNC. </li></ul> Required Skills and Abilities: <ul><li> Effective verbal and written communication skills. </li><li> Proficiency with computer skills, including navigating multiple systems and keyboarding. </li><li> Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. </li><li> Capacity to sit for extended periods, talk on the telephone, and type on the computer. </li></ul> 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: <ul><li> Registered Nurse </li></ul><ul><li> 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 </li></ul><ul><li> Must have active current and unrestricted RN licensure in state of residence. </li></ul><ul><li> May be required to obtain additional Nursing Licenses as business needs require. </li></ul> Preferred Qualifications <ul><li> Utilization review experience </li><li> Experience with LTAC, skilled rehab, or home health </li><li> Managed Care experience </li></ul> Education <ul><li> Minimum Diploma RN acceptable or Associate degree in Nursing required </li><li> BSN preferred </li></ul> 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/05/2026 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&reg;, 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 Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. <ul><li> 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. </li><li> 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</li><li> Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs </li><li> Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization </li><li> Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li><li> Typical office working environment with productivity and quality expectations. </li><li> Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. </li><li> Sedentary work involving periods of sitting, talking, listening. </li><li> Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. </li><li> Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. </li><li> Effective communication skills, both verbal and written </li></ul> Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones Education Associates Degree 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> 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.

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, 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 fulltime remote Utilization Review opportunity. Working hours are four 10hr days including every Weekend, both Saturday and Sunday, and two weekday shifts of 10hrs each (to be determined). Also includes holiday and late rotations. 12.5% Shift Premium applies once M-F training schedule completed and UMNC participating in non-traditional, weekend shift rotation. <ul><li> 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. </li><li> 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. </li><li> Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or benefit programs. </li><li> Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. </li><li> Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li><li> UMNC meets set productivity and quality expectations. </li><li> Effective communication skills, both verbal and written </li><li> Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. </li><li> Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. </li><li> Work requires sitting for extended periods, talking on the telephone and typing on the computer. </li><li>Work from home position: During work hours, Colleagues who are working from home must be available by phone, videoconference, and email in a manner and frequency that is required by the Colleague's Leader. Colleagues must be available from time to time to come into the office or client location on a given day for work-related meetings, training sessions or other events, as directed by their Leader.</li></ul> Required Qualifications <ul><li>Active and unrestricted Registered Nurse in state of residence</li><li>3+ years of experience as a Registered Nurse</li><li>1+ years of clinical experience in acute setting (ex: ER, triage, ICU, Med/Surg)</li><li>Willing and able to work four 10hr days including every Weekend, both Saturday and Sunday, and two weekday shifts of 10hrs each (to be determined), also includes Holiday and late rotations.</li><li>12.5% Shift Premium applies once M-F training schedule completed and UMNC participating in non-traditional, weekend shift rotation</li></ul> Preferred Qualifications <ul><li>Utilization review experience</li><li>Experience with LTAC, skilled rehab, or home health</li><li> Managed Care experience </li></ul> Education <ul><li>Minimum Diploma RN acceptable or Associate degree in Nursing required</li><li>BSN preferred</li></ul> 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/07/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant (Weekend)

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, 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 <ul><li> 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. </li><li> 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. </li><li> Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization . </li><li> Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li><li> Meet set productivity and quality expectations as established by UMNC. </li></ul> Required Skills and Abilities: <ul><li> Effective verbal and written communication skills. </li><li> Proficiency with computer skills, including navigating multiple systems and keyboarding. </li><li> Ability to multitask, prioritize, and adapt effectively to a fast-paced, changing environment. </li><li> Capacity to sit for extended periods, talk on the telephone, and type on the computer. </li></ul> 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: <ul><li> Registered Nurse </li></ul> <ul><li> 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 Manage ment Experience </li></ul> <ul><li> Must have active current and unrestricted RN licensure in state of residence. </li></ul> <ul><li> May be required to obtain additional Nursing Licenses as business needs require. </li></ul> Preferred Qualifications <ul><li>Utilization review experience</li><li>Experience with LTAC, skilled rehab, or home health</li><li> Managed Care experience </li></ul> Education <ul><li>Minimum Diploma RN acceptable or Associate degree in Nursing required</li><li>BSN preferred</li></ul> 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/05/2026 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&reg;, 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 <ul><li> 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. </li></ul> ` Required Qualifications <ul><li> Registered Nurse </li></ul> <ul><li> 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 Manage ment Experience </li></ul> <ul><li> Must have active current and unrestricted RN licensure in state of residence. </li></ul> <ul><li> May be required to obtain additional Nursing Licenses as business needs require. </li></ul> Preferred Qualifications <ul><li>Utilization review experience</li><li>Experience with LTAC, skilled rehab, or home health</li><li> Managed Care experience </li></ul> Education <ul><li>Minimum Diploma RN acceptable or Associate degree in Nursing required</li><li>BSN preferred</li></ul> 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/05/2026 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&reg;, 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 <ul><li> Registered Nurse </li></ul> <ul><li> 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 Manage ment Experience </li></ul> <ul><li> Must have active current and unrestricted RN licensure in state of residence. </li></ul> <ul><li> May be required to obtain additional Nursing Licenses as business needs require. </li></ul> Preferred Qualifications <ul><li>Utilization review experience</li><li>Experience with LTAC, skilled rehab, or home health</li><li> Managed Care experience </li><li>BSN preferred</li></ul> 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/12/2026 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&reg;, 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. Must Reside in PST Time Zone Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. This is a full-time, remote role. <ul><li> 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. </li><li> 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.</li><li> Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs. </li><li> Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. </li><li> Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li><li> Typical office working environment with productivity and quality expectations. </li><li> Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor. </li><li> Sedentary work involving periods of sitting, talking, listening. </li><li> Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. </li><li> Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. </li><li> Effective communication skills, both verbal and written. </li></ul> Required Qualifications <ul><li>Must reside in Pacific Standard Time Zone</li><li> 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. </li><li> Must have active current and unrestricted RN licensure in state of residence. </li><li>Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.</li></ul> Preferred Qualifications <ul><li> 2+ years of clinical experience required in med surg or specialty area .</li><li> Managed Care experience preferred, especially Utilization Management. </li><li> Preference for those residing in PST zones. </li></ul> Education <ul><li> Associates Degree required </li><li> BSN preferred </li></ul> 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> 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.

Utilization Management Nurse Consultant - Open to residents in Pacific Standard Time Zone

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> 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.

Utilization Management Nurse Consultant - San Antonio, TX Preferred

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Medicare Precertification Utilization Management Nurse Consultant position: Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours <ul><li> 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. </li><li> 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. </li><li> Communicates with providers and other parties to facilitate care/treatment </li><li> Identifies members for referral opportunities to integrate with other products, services and/or programs </li><li> Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization </li><li> Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. </li></ul> Required Qualifications <ul><li> 3+ years of experience as a Registered Nurse </li><li> Must have active current and unrestricted RN licensure in state of residence </li><li> 1+ years of Med/Surg experience </li><li> 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) </li><li> Must be willing and able to work Friday, Saturday, Sunday and Monday 10 hr shifts after approx 4-5 months of training Monday - Friday 8:30-5pm EST with occasional holiday rotation. </li></ul> Preferred Qualifications <ul><li> Prior Authorization or Utilization Management experience </li><li> Managed care experience </li><li> Experience using MedCompass </li><li> Ambulatory surgery experience </li></ul> Education Associates degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 01/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant - Weekends (4-10 hour shifts)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours. UM Nurse Consultant Fully Remote- WFH Schedule: W/Th/F/Sa (4-10hr shifts) Position Summary 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 3+ years of experience as an RN Active and unrestricted RN licensure in state of residence Able to work in multiple IT platforms/systems 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel) Preferred Qualifications Prior authorization utilization experience preferred Outpatient Clinical experience Knowledge of Medicare/Medicaid Managed care experience EST or CST Preferred time zones Education 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: $26.01 - $56.14 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 11/29/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Utilization Management Nurse Consultant Schedule: W/Th/F/Sa (4-10hr shifts)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Title: Welcome Coordinator Company: Oak Street Health Role Description: The purpose of the Welcome Coordinator at Oak Street Health is to create an inclusive environment for anyone who walks through our doors and to make a positive first and last impression on our patients. Welcome Coordinators are the face of our clinic and the glue that keeps our center operations efficient. Welcome Coordinators perform various administrative tasks that allow our broader teams to execute on creating an unmatched patient experience, deliver the best care anywhere and make Oak Street a great place to work. Welcome Coordinators juggle tasks such as scheduling patient appointments, managing inbound and outbound phone calls, as well as managing administrative tasks including fax and mail distribution. Welcome Coordinators are expected to be friendly and highly flexible. Welcome Coordinators are a part of our Service Team and report to the Practice Manager. The main focus of the Service Team is creating a seamless experience for our patients and community members. Welcome Coordinators are responsible for delivering excellent, high-touch assistance to our patients and guests everyday. Core Responsibilities: <ul><li>Welcoming patients and guests</li><li> Conducting visit check-in and assisting patients with required forms</li><li>Collecting co-pays</li><li>Updating patient information and making changes in electronic medical record platform</li><li>Scheduling/rescheduling appointments within electronic medical records platform</li><li>Managing phone lines by answering, taking messages, and conducting outbound calls as instructed</li><li>Managing faxes in the electronic fax platform</li><li>Maintaining the cleanliness of the Welcome and Community Room areas</li><li>May be required to float to other centers in the region on an infrequent basis</li><li>Other duties as assigned</li></ul> What we're looking for Required <ul><li>Strong computer skills required and basic knowledge of Google Suite</li><li>Professional phone etiquette</li><li>Fluency in Spanish, Polish, Russian, or other languages spoken by people in the communities we serve (where necessary)</li><li>US work authorization</li></ul> Strongly preferred <ul><li>Experience in customer service setting strongly preferred</li><li>Some college preferred</li></ul> Other Skills <ul><li>A flexible and positive attitude</li><li>A welcoming and nurturing attitude toward our patient population of older adults</li><li>High level of integrity</li></ul> Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $25.65 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: <ul><li> Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. </li><li> No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. </li><li> 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. </li></ul> For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 12/31/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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