Qureos Mentor

CVS Health

CVS Health is the leading health solutions company, dedicated to simplifying health care for individuals, families, and communities. With a workforce of over 300,000 colleagues, CVS Health reaches more people across America through local presence and digital channels. The company focuses on managing chronic diseases, ensuring medication compliance, and providing affordable health and wellness services. By navigating the health care system, CVS Health aims to enhance the health of communities and improve access to care.

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.
A Brief Overview
Administers operational support to clinical pharmacy staff. Conducts outreach to providers, pharmacists, and members. Supports day-to-day processes, reviews data, and documents relevant interactions. 
Position Summary
Primary responsibility is supporting Formulary Alternative Outreach Program for Medicare Part D. The Clinical Support Technician will support the operations of the Retro DUR (Drug Utilization Review)/Scorable Action Items (SAI) Clinical Pharmacy staff. This will include outreach calls to providers, pharmacists, and members. Responsibilities also include managing day-to-day processes, analyzing data, organizing and documenting all relevant interactions.<ul><li>
Executes both routine and non-routine business support tasks for the Clinical Pharmacy Support area under limited supervision, referring deviations from standard practices to managers.</li><li>
Follows area protocols, standards, and policies to provide effective and timely support.</li><li>
Conducts reviews to ensure members receive the appropriate therapy as approved by the provider, determines therapy timelines, and determines claim appropriateness.</li><li>
Initiates education for providers and pharmacies on medication options, enhancements, and alternative therapy options for members.</li><li>
Communicates with pharmacies to verify claim information and reverse unnecessary claims.</li><li>
Ability to solve problems and make decisions independently</li><li>
4+ years&rsquo; work experience</li><li>
Responsible for making prescriber and or pharmacy outreach which includes reviewing formulary vs. non-formulary prescription claims.</li><li>
Ensure member is receiving the appropriate therapy as approved by the provider and determine length of therapy and establish if current claims are appropriate.</li><li>
Review therapeutic duplication data and contact providers and pharmacies to establish correct therapy for members.</li><li>
Responsible for prescriber outreach for specific Scoreable Action Item initiatives. Work with team Pharmacist to investigate specific cases of overutilization including potential member outreach to ensure member has received products that have been dispensed under plan.</li><li>
Maintain expert knowledge in most areas of pharmacy operations. Ability to analyze and interpret various types of complex claim data under member plans. Work with pharmacies to verify claims information and reverse unnecessary claims.</li><li>
Identify opportunities for improvement in departmental and pharmacy operations with recommendations for modes of resolution.</li><li>
Train, coach, and mentor new Clinical Support Technician Staff.</li></ul>
Work from Home: Monday - Friday
Schedule: Monday - Friday, 8:00a - 5:00p local time 
Required Qualifications<ul><li>
4 or more years&rsquo; relevant experience</li><li>
Valid Pharmacy Technician Certification (PTCB or ExCPT)</li><li>
Working knowledge of Microsoft Outlook and Teams</li><li>
Ability to interpret Pharmacy Claims data</li><li>
Proficiency in computerized pharmacy systems and software applications</li><li>
Previous provider/pharmacy outreach experience</li><li>
Ability to perform duties with minimal supervision</li><li>
Proficient knowledge of Brand/Generic drug names</li></ul> 
Preferred Qualifications<ul><li>
Managed Care experience</li><li>
Advanced knowledge of Microsoft Office applications</li><li>
Understanding of medical and pharmacy terminology</li></ul>
Education<ul><li>
High School Diploma or equivalent</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $38.82
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 04/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Clinical Pharmacy Support Technician

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary:
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. 
Assessment of Members:<ul><li>
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member&rsquo;s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member&rsquo;s benefit plan and available internal and external programs/services.</li><li>
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.</li><li>
Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.</li><li>
Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.</li></ul>
Enhancement of Medical Appropriateness and Quality of Care:<ul><li>
Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member&rsquo;s needs to ensure appropriate administration of benefits</li><li>
Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes</li><li>
Identifies and escalates quality of care issues through established channels</li><li>
Ability to speak to medical and behavioral health professionals to influence appropriate member care.</li><li>
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health</li><li>
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.</li><li>
Helps member actively and knowledgably participate with their provider in healthcare decision-making</li><li>
Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.</li></ul> 
Monitoring, Evaluation and Documentation of Care<ul><li>
In collaboration with the member and their care team develops and monitors established plans of care to meet the member&rsquo;s goals</li><li>
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.</li><li>
Ability to take and manage crisis calls.</li></ul> 
Required Qualifications:<ul><li>
Unencumbered Independent Behavioral Health clinical license in the state where they reside and work:</li></ul><h3 class="jobSectionHeader">
Licensed Mental Health Counselor (LMHC)</h3><h3 class="jobSectionHeader">
Licensed Clinical Social Worker (LCSW)</h3><h3 class="jobSectionHeader">
Licensed Independent Social Worker (LISW)</h3><h3 class="jobSectionHeader">
Licensed Marital and Family Therapist (LMFT)</h3><h3 class="jobSectionHeader">
Licensed Professional Counselor (LPC)</h3><ul><li>
3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility</li><li>
3+ years minimum of Behavioral Health experience</li><li>
Applicants must be willing to work standard business hours in EST or CST.</li></ul> 
Preferred Qualifications<ul><li>
Case management and discharge planning experience
</li><li>Crisis intervention skills
</li><li>Managed care/utilization review experience
</li><li>Ability to take and manage crisis calls</li></ul>
Education
Minimum of a Master&rsquo;s degree in Behavioral/Mental Health or related field
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$54,095.00 - $142,576.00
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 05/02/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Clinical Case Manager, Behavioral Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.
Position Information
Schedule: Monday&ndash;Friday 9:30am-5:30pm EST Hours (Shift times may vary with possible weekends based on business needs)
Location: 100% Remote (U.S. only)
About Us
American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team.
Position Summary
The Appeals Nurse Consultant plays a key role in resolving clinical complaints and appeals by reviewing medical records and applying clinical guidelines for Utilization Management group. This RN must be licensed in the state that they reside, with strong experience in utilization review, coding, and managed care.
Key Responsibilities<ul><li>
Administers review and resolution of clinical complaints and appeals.</li><li>
Interprets data obtained from clinical records to apply appropriate clinical criteria and policies in compliance with regulatory and accreditation requirements for members and providers.</li><li>
Coordinates clinical resolutions with internal and external support areas.</li></ul>
Remote Work Expectations<ul><li>
This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.</li><li>
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.</li></ul>
Required Qualifications<ul><li>
Active, unrestricted RN license in your state of residence.</li><li>
3+ years Utilization Management or Utilization Review experience.</li><li>
1+ year(s) of experience demonstrating knowledge of clinical and medical policy, Milliman Care Guidelines (MCG), InterQual or other medically appropriate clinical guidelines, applicable State regulatory requirements, including the ability to easily access and interpret these guidelines.</li><li>
3+ years clinical nursing experience, with 1-3 years managed care experience in Utilization Review, Medical Claims Review, or other specific program experience as needed or equivalent experience.</li><li>
1+ year(s) of experience demonstrating knowledge of International Classification of Diseases (ICD-9), Current Procedural Terminology (CPT) coding and Healthcare Common Procedure Coding (HCPC).</li></ul>
Preferred Qualifications<ul><li>
Multistate/compact licensure privileges.</li><li>
1+ year(s) of Appeals experience in Utilization Management.</li></ul>
Education
<ul><li>Associate's degree in nursing (RN) required, BSN preferred.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,522.00 - $129,615.00
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 05/04/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Utilization Management Appeals Nurse Consultant (Remote)

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.
The Store Manager In Training (SMIT) job is a development focused role that is crafted to prepare you for a CVS Store Manager position. 
 
The SMIT program is designed to enhance your career as a future store leader. We support your development towards the store manager role by participating in a self-paced, collaborative training over the span of 16 weeks. 
 
We provide both virtual and hands on learning experiences to develop you as a leader. Our team of people, that support your growth toward your leadership career include: your District Leader, Human Resources Business Partner, Training Store Manager, and your Store Manager coach. 
 
Some of the skills needed for this role are:<ul><li>
Communicate well verbally and in writing to support and lead your team.</li><li>
Perform customer care duties to provide high levels of service.</li><li>
Execute merchandising strategies to support store sales growth.</li><li>
Manage the store inventory and assets to maintain profitability.</li></ul>
We are invested in your growth and anticipate that you will be as well. We expect our SMIT's to:<ul><li>
Actively engage with your leader in Key Learning Experiences to support you on your path to promotion during the structured program.</li><li>
Support your store as management team member and lead in a manner that is consistent with CVS values and policies.</li><li>
Engage your colleagues in support of the company's purpose of &quot;helping people on their path to better health.&quot;</li><li>
Be willing to accept promotion roles with the market that you work in.</li></ul>
Selection for the SMIT position does not guarantee promotion into a Store Manager position. Whether and when you are actually promoted to Store Manager is dependent on a variety of factors, including but not limited to performance and availability of openings.<ul><li>
 Willingness to accept a promotion to Store Manager role at any location in the designated market.</li><li>
 Ability to transfer to other CVS Pharmacy stores located within the designated market.</li><li>
 Ability to work a schedule that may vary based on business needs.</li><li>
 High School diploma or GED</li><li>
 Bachelor's Degree</li><li>
 Retail management experience, or experience as a CVS Supervisor</li><li>
A high school diploma or GED is required</li></ul><ul><li>A four year college degree is preferred, or relevant work experience may be considered in lieu of a college degree.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $26.25
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. 
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 11/22/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Store Manager in Training

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.
The Store Manager In Training (SMIT) job is a development focused role that is crafted to prepare you for a CVS Store Manager position. 
 
The SMIT program is designed to enhance your career as a future store leader. We support your development towards the store manager role by participating in a self-paced, collaborative training over the span of 16 weeks. 
 
We provide both virtual and hands on learning experiences to develop you as a leader. Our team of people, that support your growth toward your leadership career include: your District Leader, Human Resources Business Partner, Training Store Manager, and your Store Manager coach. 
 
Some of the skills needed for this role are:<ul><li>
Communicate well verbally and in writing to support and lead your team.</li><li>
Perform customer care duties to provide high levels of service.</li><li>
Execute merchandising strategies to support store sales growth.</li><li>
Manage the store inventory and assets to maintain profitability.</li></ul>
We are invested in your growth and anticipate that you will be as well. We expect our SMIT's to:<ul><li>
Actively engage with your leader in Key Learning Experiences to support you on your path to promotion during the structured program.</li><li>
Support your store as management team member and lead in a manner that is consistent with CVS values and policies.</li><li>
Engage your colleagues in support of the company's purpose of &quot;helping people on their path to better health.&quot;</li><li>
Be willing to accept promotion roles with the market that you work in.</li></ul>
Selection for the SMIT position does not guarantee promotion into a Store Manager position. Whether and when you are actually promoted to Store Manager is dependent on a variety of factors, including but not limited to performance and availability of openings.<ul><li>
 Willingness to accept a promotion to Store Manager role at any location in the designated market.</li><li>
 Ability to transfer to other CVS Pharmacy stores located within the designated market.</li><li>
 Ability to work a schedule that may vary based on business needs.</li><li>
 High School diploma or GED</li><li>
 Bachelor's Degree</li><li>
 Retail management experience, or experience as a CVS Supervisor</li><li>
A high school diploma or GED is required</li></ul><ul><li>A four year college degree is preferred, or relevant work experience may be considered in lieu of a college degree.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $23.88
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. 
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 11/22/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;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 &ndash; helping to simplify health care one person, one family and one community at a time.
The Store Manager In Training (SMIT) job is a development focused role that is crafted to prepare you for a CVS Store Manager position. 
 
The SMIT program is designed to enhance your career as a future store leader. We support your development towards the store manager role by participating in a self-paced, collaborative training over the span of 16 weeks. 
 
We provide both virtual and hands on learning experiences to develop you as a leader. Our team of people, that support your growth toward your leadership career include: your District Leader, Human Resources Business Partner, Training Store Manager, and your Store Manager coach. 
 
Some of the skills needed for this role are:<ul><li>
Communicate well verbally and in writing to support and lead your team.</li><li>
Perform customer care duties to provide high levels of service.</li><li>
Execute merchandising strategies to support store sales growth.</li><li>
Manage the store inventory and assets to maintain profitability.</li></ul>
We are invested in your growth and anticipate that you will be as well. We expect our SMIT's to:<ul><li>
Actively engage with your leader in Key Learning Experiences to support you on your path to promotion during the structured program.</li><li>
Support your store as management team member and lead in a manner that is consistent with CVS values and policies.</li><li>
Engage your colleagues in support of the company's purpose of &quot;helping people on their path to better health.&quot;</li><li>
Be willing to accept promotion roles with the market that you work in.</li></ul>
Selection for the SMIT position does not guarantee promotion into a Store Manager position. Whether and when you are actually promoted to Store Manager is dependent on a variety of factors, including but not limited to performance and availability of openings.<ul><li>
 Willingness to accept a promotion to Store Manager role at any location in the designated market.</li><li>
 Ability to transfer to other CVS Pharmacy stores located within the designated market.</li><li>
 Ability to work a schedule that may vary based on business needs.</li><li>
 High School diploma or GED</li><li>
 Bachelor's Degree</li><li>
 Retail management experience, or experience as a CVS Supervisor</li><li>
A high school diploma or GED is required</li></ul><ul><li>A four year college degree is preferred, or relevant work experience may be considered in lieu of a college degree.</li></ul>
Anticipated Weekly Hours
45
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $23.88
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. 
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. 
Additional details about available benefits are provided during the application process and on Benefits Moments. 
We anticipate the application window for this opening will close on: 06/20/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Join CVS Health and explore 447   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

CVS Health

About Company

Clinical Pharmacy Support Technician

Clinical Case Manager, Behavioral Health

Clinical Case Manager, Behavioral Health

Utilization Management Appeals Nurse Consultant (Remote)

Store Manager in Training

Store Manager in Training

Store Manager in Training