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. *Position Summary* The manager of Clinical Health Services Utilization Management will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Oversight and management of clinical team processes including the organization and development of high performing teams. *Responsibilities include:* * Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. * Accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures * Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable) * Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care * May act as a liaison with other key business areas. * May develop/assist in development and/review new training content * Protects the confidentiality of member information and adheres to company policies regarding confidentiality * Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes * Develop, initiate, evaluate, monitor, and communicate performance expectations * Ensures the team's understanding and use of information system capability and functionality * Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills * Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams * Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance * Consistently demonstrates the ability to serve as a model change agent and lead change efforts * Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed * Accountable for maintaining compliance with policies and procedures and implements them at the employee level * Communicate effectively with Providers, Members, Staff and other Leaders *Required Qualifications* * Must have active, current and unrestricted RN licensure state of residence * Must have compact RN state licensure * 3+ years in clinical area of expertise. * 3+ years Utilization Management experience * MS Office Suites experience * 2+ year's managed care experience is required * Ability to work core business hours, Monday-Friday, 8am-5pm, with flexibility to work occasional weekend hours is required. Ability to provide on-call UM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency *Preferred Qualifications* * Utilization Management prior authorization experience * 2+ year's managed care experience * Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually *Education* Associates Degree required BSN preferred *Pay Range* The typical pay range for this role is: $87,035.00 - $187,500.00This 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: 05/10/2024
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