• Job Description

  Req#: R0851568
  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
  
  This is a telework role but must reside in the state of California.
  Up to 10% of travel within the state of California required.
  Schedule is Monday-Friday, standard business hours.
  
  Roles and Responsibilities:
  
  • Accountable for conducting oversight of external entities that are contracted to perform clinical functions on Aetna's behalf.
  • Monitor and track delegated entities compliance with regulatory and NCQA requirements.
  • Communicate to delegated entities about industry standards, Aetna policies, and best practices to improve overall quality program.
  • Accountable for preparing delegation oversight evidence for NCQA and regulatory reviews.
  • Participate in industry collaboratives.
  • This position supports NCQA, CMS, and other regulatory compliance initiatives.
  
  
  Required Qualifications
  
  • One of the following clinical licenses is required: LPN, LVN, or RN
  • Must reside in California
  • 3+ years of Utilization Management and/or Case Management experience
  
  
  Preferred Qualifications
  
  • 2+ years Delegation Auditing/Oversight experience
  • Strong communication skills with external clients, primarily regulatory and accreditation partners
  
  
  Education
  
  • Bachelors degree preferred
  • CA clinical licensure required
  
  
  Anticipated Weekly Hours
  40
  
  Time Type
  Full time
  
  Pay Range
  
  The typical pay range for this role is:
  
  $46,988.00 - $112,200.00
  
  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: 04/05/2026
  
  Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• About the company

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