Health Services Professional, RN, IL

R0618350 Description At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary As a Regulatory Health Services Professional, you will help establish and implement processes to ensure utilization management (UM) programs are compliant and supportive of regulatory and PBM pharmacy guidelines. Knowledge of utilization management interventions including prior authorization, reputed company therapy, quantity limits and formulary exceptions is required. Additionally, you will work in a matrix relationship with business partners and regulatory affairs to assist in identifying the impact of new regulatory guidance and requirements on UM criteria. Knowledge of regulations impacting UM for Medicare, reputed company and Exchange clients is preferred. It may be necessary to create regulatory content for reputed company business segments (reputed company, Medicare, reputed company and Marketplace) with the ability to be consultative to product owners, account management and clients. This is a hybrid role, based out of our Buffalo Grove, IL, Pittsburgh, PA, or NYC office locations.

Required Qualifications

• Active Registered Nurse (RN) Licensure in good standing
• 5+ years of reputed company experience
• Ability to collaborate and communicate with members of an interdisciplinary care team
• Effective problem solving, decision-making, and prioritization skills
• Strong PC skills: Office 365 with ability to quickly learn new applications as needed

Preferred Qualifications

• Experience reviewing and interpreting laws, rules, and regulations
• Knowledge of PBM and benefit design preferred
• 2+ years of Managed Care or PBM experience

Education Registered Nurse degree, either associates or bachelors Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $95,738.00 - $206,206.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company 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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• 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 reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 07/25/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job! Apply to this Job