Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. This position is a *hybrid position* and requires the candidate to work from office *3 days a week *( Tuesdays, Wednesdays and Thursdays) at the nearest CVS Health or Aetna office. *Core duties:* * Partner with Medicaid Care Management, NCQA, Compliance and Audit leads to analyze and support policies and processes at national and market levels. * Works to establish and maintain collaborative relationships by fostering excellent customer response and appropriate problem resolution. * Collaborates with leadership throughout the organization to develop and implement program strategies in meeting business objectives, as well as CMS, federal and state regulations, and accrediting agency requirements across the plans in a matrix environment. * Demonstrates expertise in all care management processes to act as primary resource for program oversight, consultation. * Represents advanced level of knowledge and training related to system technology and data analytics for CM process integration * Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plans function *Required Qualifications* * 3+ years of experience in Medicaid Care Management * Must have an active and unrestricted RN license or Behavioral Health license (e.g. LCSW, LPC/LCPC) in the state of candidate's residence. * 3+ years of demonstrated experience in managing large initiatives and projects * 3+ years of experience working collaboratively with internal and external teams to build knowledge and improve processes * 3+ years of experience in data analysis and uses this to drive medical management strategy· * 3+ years of experience successfully building, maintaining, and supporting effective relationship * 3+ years of experience in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software * Must be willing and able to travel up to 15% anywhere in US to attend on site meetings/trainings etc. on as need basis. *Preferred Qualifications* * Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management * Participate in strategic projects and process improvements based on lessons learned. * Knowledge of medical management regulations, standards, and policies * Ability to evaluate and interpret data for the purpose of developing and revising new programs and processes to meet business demand across cross-functional teams to achieve goals and to improve plan outcomes * 5+ years of experience communicating with all levels of an organization from C-Suite executives to front-line staff (written and verbal) * Profound understanding of clinical workflows and best practices * Ability to effectively manage expectations and inspire confidence. * Knowledge of Visio, NCQA, policy and process development and ability to understand contract requirements. * Lean Six Sigma Certification Preferred *Education* * Master's degree required for BH License * Bachelor's degree required for RN license *Pay Range* The typical pay range for this role is: $84,357.00 - $181,700.00This 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 05/27/2024
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