RN Manager – Delegation Compliance

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $88.4k - $190.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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. • Responsible for suggesting methods to improve area operations, efficiency, and service to both internal and external staff. • Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model.

🎯 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 • Proficient with Microsoft Office, Google Suite, and healthcare EMRs

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support physical, emotional, and financial well-being