Health Services Professional, RN, IL

R0618350 Description 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 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, step 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, Medicaid and Exchange clients is preferred. It may be necessary to create regulatory content for all business segments (Commercial, Medicare, Medicaid 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 healthcare 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 Range The typical pay range for this role is: $95,738.00 - $206,206.00 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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all 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 access 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 close on: 07/25/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job