Care Manager Rn in United States

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. Utilization Management Nurse Consultant (RN) Make a meaningful impact on patient care from wherever you are. We are seeking an experienced Registered Nurse (RN) to join our Utilization Management team. In this role, you will use your clinical expertise to review healthcare services, support appropriate care decisions, collaborate with providers, and help members navigate their healthcare journey. What You'll Do Review clinical information and apply evidence-based criteria to make coverage recommendations. Collaborate with healthcare providers and internal teams to support quality patient outcomes. Identify opportunities for care coordination and member support programs. Promote effective healthcare utilization and contribute to high-quality service delivery. Manage multiple systems and priorities in a fast-paced, team-oriented environment. Required Qualifications Active, unrestricted RN license in your state of residence. Minimum 2 years of RN experience in an adult acute care or critical care setting . Associate's Degree in Nursing. Strong communication, computer, and multitasking skills. Ability to work schedules that may include evenings, weekends, and holidays as part of a 24/7 operation. Preferred Qualificatio

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 CVS Health Prescription Records team serves as the sole managing interface for CVS Retails’ legal, subpoena, regulatory, attorney, patient and third-party record demands for patient and prescriber prescription records. This position will handle incoming customer inquiries by phone, fax and email in a contact center environment. You will have high-volume data entry expectations of these requests while ensuring the accuracy of details provided, along with being in charge of responsibly handling Protected Health Information. We have the responsibility of complying with regulatory demands and subpoena demands in accordance with state and federal HIPAA/Privacy requirements. Role Overview Shift: Monday-Friday 8:30-5:00 PM EST Hybrid: Must be able to work 2 days a week in the Cumberland, RI office. (Thursday are mandatory) Training Schedule: First 2 weeks training fully onsite in Cumberland following the regular schedule of 8:30-5:00 PM EST What you will do Work in a high volume, production oriented, time sensitive Call Center environment. Assist customers on the phone to provide Prescription Records and status updates on their requests. Process prescription records in a data entry system in response to fax, mail, and email requests from Regulatory Agencies, Courts (S

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. A Brief Overview Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp

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. A Brief Overview Performs claim documentation review, verifies policy coverage, assesses claim validity, communicates with healthcare providers and policyholders, and ensures accurate and timely claims processing. Contributes to the efficient and accurate handling of medical claims for reimbursement through knowledge of medical coding and billing practices and effective communication skills. What you will do Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and strict adherence to policies and guidelines. Determines the eligibility and coverage of benefits for each claim based on the patient's insurance plan and policy guidelines and scope. Assesses claims for accuracy and compliance with coding guidelines, medical necessity, and documentation requirements. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims. Conducts reviews and investigations of claims that require additional scrutiny or validation to ensure proper claim resolution. Communicates with healthcare providers, patients, or other stakeholders to resolve any discrepancies or issues related to claims.</sp

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once

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. Job Purpose and Summary: At CVS Health, we are focused on transforming health care for our customers and making our company a great place to work. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. Within our Retail locations, we bring this promise to life with heart every day and our Pharmacy Technicians (Technicians) play a critical role in supporting our pharmacy teams to consistently deliver on our brand promise. As a Technician, you will support the pharmacy team in delivering operational and service excellence within your store. Technicians are often the first point of contact to assist our patients and customers to deliver an exceptional experience. Technicians assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients’ prescriptions are filled promptly, safely, and accurately, and we are providing caring service that exceeds patient expectations. Technicians operate as part of the pharmacy team through consistent application of Standard Operating Procedures (SOPs), best practices, and effective communication. Throughout their shifts and in all customer and colleague interactions, they demonstrate genuine care and contribute to a safe and inclusive culture where all people feel valued and empowered. Once