Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting. As a Utilization Management Registered Nurse: You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?) You will communicate with providers, members, or other parties to facilitate care and treatment. You will help deliver coordinated care for our members You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact Required Qualifications: Must hold Compact Registered Nurse (RN) license in your state of residence Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting. Must be passionate about contributing to an organization focused on improving consumer experiences Preferr

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 Location: Work From Home – Flexible, Travel Required: 25 – 50% (Wayne and Macomb Counties) Schedule: Standard business hours Monday-Friday 8:00am-5:00pm EST No evenings, weekends, or major holidays 4 day/10-hour schedule available after training ​ Our Mission The LTSS RN Case Manager is responsible for comprehensive assessment, care planning, coordination, implementation, and monitoring of Long-Term Services and Supports (LTSS) for dual-eligible Medicare and Medicaid members. This role ensures members receive appropriate waiver and community-based services to promote safety, independence, and improved health outcomes while maintaining regulatory compliance. This position includes in-home visits to complete functional assessments, evaluate eligibility for waiver services, and develop person-centered service plans. Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and

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 position is responsible for performing utilization management (UM) reviews and authorization activities for post-acute services, including Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), Long-Term Acute Care Hospitals (LTACH), Home Health, and other post-acute levels of care. The UM Nurse Consultant evaluates medical necessity and appropriateness of services utilizing clinical criteria, applicable policies, and regulatory requirements to support quality, cost-effective care. The UM Nurse Consultant collaborates with providers, care managers, medical directors, and interdisciplinary teams to facilitate timely care transitions, ensure member needs are met, and support organizational goals. This role requires independent clinical judgment, strong critical thinking skills, and the ability to manage multiple priorities in a fast-paced environment. Required Qualifications Active, unrestricted Registered Nurse (RN) license in the state of residence. Ability to obtain and maintain additional state licensure as required by business needs. 3+ years of clinical nursing experience. 1+ years of utilization management, case management, discharge planning, managed care, or post-acute care experience. Experience reviewing medical records and applying evidence-based

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. Registered Nurse must hold a CDCES- Certified Diabetes Care and Education Specialist This is a full-time telework role for a RN who resides in a compact state and holds a compact license. Working schedule: Monday-Friday, standard business hours, including 1 evening shift per week from 12:30- pm EST -The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status for chronic conditions. - Assessment of members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. -Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. -Enhancement of Medical Appropriateness & Quality of Care: -Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. -Usi

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. As a Registered Nurse (RN), Home Infusion you will work outside the walls of a hospital setting in a growing specialized area of the nursing field. If you are spending 12 hours on your feet or rushing from patient to patient with no time to provide quality patient care, this would be the perfect opportunity to change your work environment. Our nurses have the time and a balanced schedule to build strong one-on-one relationships with their patients and their families. In this role you will work up to 20 hours per week seeing patients in Des Moines Iowa and surrounding areas. Could travel up to 2 hours one way to see a specialty patient. You will be paid for all travel time and reimbursed mileage. On call- 2 weekend shifts per month. On-call pay. (not currently required) As a Home Infusion Nurse you will… - Challenge your clinical nursing (RN) skills by receiving continuous training on leading edge technology and clinical requirements in specialty infusion. Certification and recertification expenses can be reimbursed for eligible RN’s such as Certified Registered Nurse of Infusion (CRNI®)! - Provide a broad range of infusion therapies in our patients’ homes - Make a difference by using your clinical IV experience and personal touch to assist our patients recover in the comfort of their own home. - Provide one-on-one home infusion nursing care visits and patie

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. As a Registered Nurse (RN), Home Infusion you will work outside the walls of a hospital setting in a growing specialized area of the nursing field. If you are spending 12 hours on your feet or rushing from patient to patient with no time to provide quality patient care, this would be the perfect opportunity to change your work environment. Our nurses have the time and a balanced schedule to build strong one-on-one relationships with their patients and their families. In this role you will work up to 20 hours every week seeing patients in Metro St. Louis and some areas in Illinois. Could travel up to 2 hours one way to see a specialty patient. You will be paid for all travel time and reimbursed mileage. On call is not currently required. As a Home Infusion Nurse you will: - Challenge your clinical nursing (RN) skills by receiving continuous training on leading edge technology and clinical requirements in specialty infusion. Certification and recertification expenses can be reimbursed for eligible RN’s such as Certified Registered Nurse of Infusion (CRNI®)! - Provide a broad range of infusion therapies in our patients’ homes - Make a difference by using your clinical IV experience and personal touch to assist our patients recover in the comfort of their own home. - Provide one-on-one home infusion nursing care visits and patient education in accordance with th