Health Services Manager, IC
Description:
• Multifunctional program manager to review, assess impact and implement State and Federal Regulations
• Work with legal, compliance and utilization management stakeholders to support legal mandate/compliance changes & audits
• Provide consultative support & clarification of implemented mandates and ensure documents are current and accurate
• Part of the Utilization Management Center of Excellence responsible for Clinical Services utilization management and specialty program policies/procedures
• Review and implement regulations across all lines of business (Commercial, Medicare, Medicaid)
• Review policy, job aids and workflows; draft and lead implementation of regulatory changes
• Develop and implement strategy for policy/program development considering systems, actuarial, marketing and impacts on managed care products
• Operationalize strategy: prioritize projects, design programs, develop policies, involve SMEs, design/manage implementation, communications and training
• Analyze ongoing performance data and initiate/implement changes
Requirements:
• 3+ years minimum of utilization management - Clinical Operations experience
• 3+ Experience & knowledge of Medicare & CMS compliance
• 3+ Experience in implementing new programs/changes in UM space
• Knowledge of Commercial, Medicare, Medicaid, Duals LOB (preferred)
• RN license preferred
• PMP Certification (preferred)
• Bachelor's degree or equivalent experience
Benefits:
• Affordable medical plan options
• 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
• 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
Apply Now
Apply Now
• Multifunctional program manager to review, assess impact and implement State and Federal Regulations
• Work with legal, compliance and utilization management stakeholders to support legal mandate/compliance changes & audits
• Provide consultative support & clarification of implemented mandates and ensure documents are current and accurate
• Part of the Utilization Management Center of Excellence responsible for Clinical Services utilization management and specialty program policies/procedures
• Review and implement regulations across all lines of business (Commercial, Medicare, Medicaid)
• Review policy, job aids and workflows; draft and lead implementation of regulatory changes
• Develop and implement strategy for policy/program development considering systems, actuarial, marketing and impacts on managed care products
• Operationalize strategy: prioritize projects, design programs, develop policies, involve SMEs, design/manage implementation, communications and training
• Analyze ongoing performance data and initiate/implement changes
Requirements:
• 3+ years minimum of utilization management - Clinical Operations experience
• 3+ Experience & knowledge of Medicare & CMS compliance
• 3+ Experience in implementing new programs/changes in UM space
• Knowledge of Commercial, Medicare, Medicaid, Duals LOB (preferred)
• RN license preferred
• PMP Certification (preferred)
• Bachelor's degree or equivalent experience
Benefits:
• Affordable medical plan options
• 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
• 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
Apply Now
Apply Now