CVS Health

Consultant

• Review authorization requests across a broad range of medical specialties
• Evaluate medical necessity using clinical records, evidence-based guidelines, and benefit plan requirements
• Apply InterQual, MCG, or similar clinical criteria to support authorization determinations
• Collaborate with providers, care managers, medical directors, and interdisciplinary teams
• Ensure compliance with health plan policies, regulatory requirements, and clinical standards
• Manage a high-volume caseload while meeting productivity, quality, and turnaround-time expectations
• Support effective healthcare utilization and positive member outcomes
• Work remotely from a designated home workspace

Concurrent Review UM Nurse Consultant

Pharmacist

• Support the pharmacy team in delivering operational and service excellence within the store
• Assist patients and customers and provide an exceptional experience
• Ensure prescriptions are filled promptly, safely, and accurately
• Follow company SOPs and pharmacy workflow procedures at production, pick-up, drive-thru, and drop-off workstations
• Serve patients with empathy and genuine care at pick-up, drive-thru, and over the phone
• Offer immunizations and other services at the register and over the phone, where permitted
• Solve or escalate patient problems
• Complete inventory activities such as putting away medication deliveries, cycle counts, returns-to-stocks, and waiting-bin inventories
• Contribute to a high-performing, safe, inclusive, and engaging team
• Expand clinical and technical knowledge and respond to feedback
• Remain flexible for scheduling and business needs, including voluntarily traveling to nearby stores for shifts
• Comply with pharmacy laws, regulations, professional standards, ethical principles, and CVS policies
• Deliver additional health care services such as immunizations, point-of-care testing, and staffing offsite clinics when allowed and properly trained
• Where permissible, support immunizations by obtaining Technician Immunizer status, educating patients, monitoring adverse reactions, documenting patient information, and managing vaccine supplies
• Perform additional tasks directed by the Supervisor or Manager

Pharmacy Technician

• Conduct concurrent reviews for inpatient admissions and continued stays
• Evaluate clinical documentation and determine medical necessity using established guidelines and evidence-based criteria
• Collaborate with hospitals, physicians, utilization review departments, and care teams to support appropriate levels of care
• Facilitate timely discharge planning and care transitions
• Monitor ongoing inpatient treatment and identify opportunities to improve healthcare utilization and outcomes
• Communicate recommendations and clinical findings to providers and internal stakeholders
• Support effective resource utilization while maintaining quality and compliance standards

Nurse Consultant

Community Health Worker

• Conduct home visits with Aetna members with chronic conditions
• Reinforce care-plan adherence and adapt tasks to members’ culture, language, and religion
• Educate healthcare professionals and providers about social determinants of health
• Build relationships with members, providers, nurse case managers, agencies, supervisors, and office staff
• Reduce cultural and socioeconomic barriers between clients and institutions
• Assist with care-plan implementation, member education, care-management strategies, and community linkages
• Help members identify socioeconomic issues and develop health/social management plans and goals
• Identify care-system gaps and help members access community services and eligible programs
• Schedule social-service appointments and assist with applications
• Support medication adherence, medication reviews, and refill acquisition
• Teach disease self-management, including nutrition and symptom tracking
• Accompany members to appointments as needed
• Maintain electronic health records, compile reports, complete progress notes and letters, and perform administrative duties
• Travel extensively to client homes, community locations, agencies, and outreach destinations

Program Manager

• Lead the work and deliverables of multiple, complex projects or programs through implementation
• Manage cross-functional business projects
• Identify or serve as subject matter expert on key business projects and initiatives
• Develop and support cross-functional management processes to help achieve growth objectives
• Develop experience and journey maps for key constituents
• Support strategic planning by collaborating with stakeholders to gather and coordinate inputs and ensure alignment to enterprise priorities
• Serve as a resource to ensure compliance and appropriateness of key external communications
• Support the leader in managing the team, including town halls, team meetings, and culture initiatives

Senior Project Program Manager, Dental and Vision

Nurse

• Collaborate and inform the case management process using critical thinking and judgment
• Facilitate appropriate healthcare outcomes for members
• Assist with appointment scheduling
• Identify and assist members with accessing benefits and education
• Use care management tools and resources
• Serve dual eligible Medicare and Medicaid populations with complex health and social challenges
• Collaborate with members, providers, and community organizations
• Address members’ healthcare and social determinant needs
• Travel up to 50–75% of the time from the home location in and around Cook County and surrounding areas
• Work independently from a designated home workspace and collaborate with teams virtually
• Navigate multiple systems and applications, including secure VPN and EHR portals
• Communicate through email, calendar invites, Teams messaging, and virtual meetings
• Resolve common technical issues and contact IT when needed

Case Manager, Registered Nurse – Field

Manager

• Oversee the implementation of healthcare management services for the assigned functional area
• Maintain policies and procedures in accordance with regulatory and accreditation standards, including NCQA and URAC
• Implement and monitor best-practice approaches and innovations across the continuum of care
• Act as a liaison with key business areas
• Manage resources responsible for member identification, care-plan development, medical appropriateness, quality of care, and care monitoring and documentation
• Handle an assigned caseload when required
• Serve as a point of contact for customers and Account Teams, including customer meetings and new-customer implementation
• Assess developmental needs and implement action plans supporting high-performing teams
• Promote teamwork, cross-product integration, and continuum-of-care thinking
• Lead change efforts and serve as a change agent
• Collaborate with licensed staff overseeing clinical staff and licensed personnel activities
• Mentor the team on practice standards, intervention quality, problem resolution, and critical thinking

Associate Manager, Clinical Health Services – RN, LCSW, LCPC

• Apply critical thinking, evidence-based clinical criteria and clinical practice guidelines to services requiring precertification
• Collect and review clinical information from providers by phone and computer
• Use specific criteria to authorize procedures and services
• Initiate Medical Director referrals when needed
• Perform sedentary desk-based work involving sitting, talking, listening and computer use
• Navigate multiple systems, monitors and applications to streamline tasks
• Communicate through email, calendar invites, Teams and virtual meetings
• Access secure systems and maintain computer and information security
• Troubleshoot common technical issues and contact IT for unresolved issues

Utilization Management Nurse Consultant

• Serve as a bridge between Aetna members and the healthcare system through outreach and education
• Conduct home visits with members with chronic conditions and reinforce care-plan adherence
• Adjust services to members’ culture, language, and religion
• Identify healthcare needs, improve access to care, and reduce unnecessary hospitalizations
• Educate healthcare professionals and providers about social determinants of health
• Build and maintain relationships with members, providers, nurse case managers, agencies, supervisors, and office staff
• Reduce cultural and socioeconomic barriers between clients and institutions
• Assist with care-plan implementation, member education, and care-management strategies
• Link members to health and social services and help identify management plans and goals
• Identify care-system gaps and help members use community services, schedule appointments, and complete program applications
• Support medication adherence by reviewing medication lists and assisting with refills
• Teach disease self-management, including nutrition and symptom tracking
• Accompany members to appointments as needed
• Maintain member records in electronic health records, compile reports, complete progress notes and letters, and perform administrative duties
• Travel extensively to client homes, community locations, agencies, and outreach destinations
• Work under the direction of a designated professional

Community Health Worker – Field

Customer Support

• Serve as the primary point of contact for members, providers, and plan sponsors
• Deliver customer service through phone, digital, and written communication channels
• Resolve routine and complex customer concerns
• Document customer interactions and maintain detailed records
• Educate customers on plan benefits, policies, procedures, and self-service tools
• Identify customer needs and provide personalized solutions and recommendations
• Research and resolve claims, eligibility, billing, enrollment, and benefit-related issues
• Coordinate escalations and referrals to appropriate departments
• Pursue first-call resolution whenever possible
• Maintain productivity, quality, compliance, and customer satisfaction standards
• Support appeals, grievances, complaints, and authorization-related inquiries
• Use multiple systems and resources to investigate issues and provide accurate information
• Adhere to HIPAA, regulatory requirements, and privacy and confidentiality policies
• Participate in training, coaching, and continuous improvement initiatives
• Share knowledge and support organizational goals

Customer Service Representative

• Serve as a bridge between Aetna members and the healthcare system through outreach and education
• Conduct home visits with members who have chronic conditions
• Reinforce care-plan adherence and adapt tasks to members’ culture, language, and religion
• Educate healthcare professionals and providers about social determinants of health affecting members
• Build and maintain relationships with members, providers, case managers, agency representatives, supervisors, and office staff
• Reduce cultural and socioeconomic barriers between clients and institutions
• Assist with care-plan implementation, member education, and care-management strategies
• Link members to health and social services and help identify socioeconomic issues affecting health
• Identify gaps in community care systems and assist members with community services, appointments, transportation vendors, and program applications
• Support medication adherence by reviewing medication lists and helping members obtain refills
• Teach disease self-management, including nutrition and symptom tracking/reporting
• Accompany members to appointments as needed
• Maintain member records in electronic health record systems and complete progress notes, letters, reports, and other documentation
• Travel extensively to client homes, community locations, agencies, and outreach destinations

• Assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members
• Gather clinical information and apply clinical criteria, guidelines, policies, procedures, and clinical judgment to render coverage determinations or recommendations
• Communicate with providers and other parties to facilitate care and treatment
• Identify members for referral opportunities involving other products, services, and programs
• Identify opportunities to promote quality and effectiveness of healthcare services and benefit utilization
• Consult with and provide expertise to internal and external constituents in coordinating and administering utilization and benefit management
• Work in a typical office environment with productivity and quality expectations
• Perform sedentary work involving extended periods of sitting, telephone communication, listening, and computer typing

Associate

• Manage and monitor inbound and outbound authorization work queues
• Receive, review, and process authorization requests and supporting documentation
• Review requests for completeness and identify missing or incomplete information
• Route authorization requests to the appropriate team or department
• Process fax, email, and electronic submissions related to service authorization activities
• Respond to authorization-related inquiries and provide status updates
• Enter and maintain accurate information within authorization and care management systems
• Document actions and maintain required records
• Support administrative and operational workflows related to service authorizations
• Monitor pending requests and assist with follow-up activities
• Maintain productivity, accuracy, and quality standards while managing a high-volume workload
• Assist with special projects, backlog reduction efforts, and operational initiatives

Inbound/Outbound Queue Associate

Therapist

• Provide psychosocial support and education to individuals, couples, and families ages 13+
• Practice at the top of license with support from the clinical care team
• Build and grow the MinuteClinic practice
• Deliver evidence-based mental health care
• Conduct diagnostics, care collaboration, treatment planning, and short-term counseling
• Use motivational interviewing, problem solving therapy, and cognitive behavioral therapy
• Support continuity of care using assessment and treatment planning tools
• Deliver virtual therapy and engage patients across multiple platforms
• Provide crisis intervention and collaborate with patients and care teams

Mental Health Therapist

• Guide, coach, and mentor members seeking individualized mental health and substance use recovery goals
• Use personal recovery experience to help the Aetna team coordinate member care
• Share coping strategies, wellness tools, and resources with care managers and coordinators
• Conduct field-based, face-to-face, and virtual member visits
• Attend case rounds and help identify members who may benefit from Peer Support Services
• Educate care management teams on peer support services and recovery goals
• Collaborate with healthcare professionals, providers, members, and community agencies
• Help members identify socioeconomic issues and develop person-centered plans and goals
• Attend medical, behavioral health, or community appointments when appropriate
• Advocate for members’ needs and individualized goals
• Connect members with community-based services and supports
• Research available community-based supports and services
• Use open-ended questions to engage members in dialogue
• Document non-clinical, person-centered member outreach notes
• Manage schedules, competing projects, and demands independently
• Maintain continuing education requirements for Louisiana Peer Support Specialists

Concurrent Review UM Nurse Consultant

Pharmacy Technician

Nurse Consultant

Community Health Worker

Senior Project Program Manager, Dental and Vision

Case Manager, Registered Nurse – Field

Associate Manager, Clinical Health Services – RN, LCSW, LCPC

Utilization Management Nurse Consultant

Community Health Worker – Field

Customer Service Representative

Community Health Worker – Field

Utilization Management Nurse Consultant

Inbound/Outbound Queue Associate

Mental Health Therapist

Certified Peer Support Specialist