Rn Manager, Delegation Compliance, CVS Health

CVS Health

Location:
United States

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

88374.00 - 190344.00 USD / Year

Save Job

Apply Position

Job Description:

This position is responsible for a range of activities supporting delegated Care Management and Utilization Management functions. These may include, but are not limited to, responsibility for implementation of new delegated functions, project planning, system readiness, adherence to compliance requirements, training, and communication. The Manager ensures program compliance, provides initial and ongoing education to staff, and serves as a liaison with health plans and partners.

Job Responsibility:

Oversee compliance for UM and CM to deliver an unmatched patient experience and ensure delegation compliance
Audit individual charts according to QA Audit Protocols to ensure compliance with program responsibilities and best practices
Possess knowledge of contractual, accreditation, federal and business requirements for assigned program and ensure compliance with program requirements and develop corrective action plans as needed
Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives
Establish workflows that meet compliance requirements and align with organization-wide clinical protocols
Lead the review of policies and procedures, program descriptions, and evaluations
Conduct training for new team members and other internal parties as required
Provide statistical and performance feedback, and coaching on a regular basis to each team member in their assigned region
Create and maintain a high-quality work environment so team members are motivated to perform at their highest level
Provide continual evaluation of processes and procedures
Suggest methods to improve area operations, efficiency, and service
Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model
Serve as point of contact for / management of health plan relationships related to delegated care management
Oversight of delegated entities and internal operating partners servicing Care Coordination
Complete report submissions, including validation where needed

Requirements:

Bachelor’s in Nursing
Active RN license within one or more OSH states
Willingness to obtain cross-state licensure, as needed
5+ years of healthcare experience, preferably in a primary care and/or managed care setting
2+ years direct supervisory experience
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
Knowledge of Medicare/Medicaid and NCQA requirements
Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements
Demonstrated experience leading teams, competence with change management, and leading process improvement
Knowledge relating to healthcare delivery workflows, project management, and quality improvement is required
Prior experience in a similar role at an IPA, Health Plan or MSO will be advantageous
Strong teamwork and interpersonal skills
Must be able to work effectively with cross functional groups, fostering teamwork with a commitment to quality
Passion for excellence, willing to go the extra mile to achieve objectives and ensure consistently high quality work product
Ability to succinctly summarize and synthesize large amounts of information
Quick learner comfortable with a high level of ambiguity
Strong accountability and discipline against timelines and deliverables
Strong clinical and assessment skills
Outstanding verbal and written communication skills
Ability to work independently and maintain flexibility in a fast-paced, start-up environment
Self-starter with a high level of accountability and responsibility for the outcome of care
Highly organized and able to manage multiple priorities appropriately
Independent problem-solving skills
Able to work collaboratively and build enduring relationships with providers, patients and the multidisciplinary team
A flexible, positive attitude
Proficient with Microsoft Office, Google Suite, and healthcare EMRs
US work authorization
Someone who embodies being “Oaky”

Nice to have:

Prior experience in a similar role at an IPA, Health Plan or MSO
Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for wellness screenings, tobacco cessation and weight management
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
May 13, 2025

Expiration:
November 01, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Rn Manager, Delegation Compliance