Associate Manager - Duals Utilization Management Prior Authorization
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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 Associate Manager is responsible for oversight of Utilization Management/Case Management staff. This position is responsible for the development and monitoring of high performing teams. Works closely with functional area leadership team (department Associate Managers, Manager, and other key stakeholders such as program design/product, Medical Directors, account teams/plan sponsor liaisons, etc.) to ensure consistency in clinical interventions supporting our members.
The Associate Manager role includes (but is not limited to):
- Accountable for meeting the financial, operational, and quality objectives of the unit.
- Oversees the implementation of healthcare management services for assigned functional area
- Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)
- Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
- Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
- Drive operational excellence by streamlining processes and workflows to drive efficiencies, leveraging technology to streamline and simplify
- May act as a liaison with other key business areas.
- May develop/assist in development and/review new training content
- May collaborate/deliver interdepartmental training sessions
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality
- May collaborate with leadership for the development of, monitoring and communicating performance expectations
- Ensures the team's understanding and use of information system capability and functionality
- May act as a single point of contact for the customer and the Account Team including participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
- 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
Required Qualifications:
- Must have active, current and unrestricted RN Licensure in state of residence
- Must be willing and able to work Monday through Friday 8:00 to 5:00pmCST zone
- Must be able to work occasional late week day and/or weekend coverage
- Must be able to work holiday coverage rotation per the needs of the department
- 3+ years inpatient clinical experience as a Registered Nurse
- 3+ years of Managed Care experience
- 1+ years of Utilization Management experience
- 1+ year Leadership experience (formal or informal roles)
- Travel Required up to 5% for meetings/audits
- 1+ years of MS office suites experience
Preferred Qualifications:
- Experience with MedCompass
- Medicaid/Medicare/Duals experience
- Ability to communicate effectively with Providers, Members, Staff, and other Leaders both in oral and written formats
- Ability to evaluate and interpret data, identifies areas of improvement
- Time efficient and highly organized
- Exceptional communication skills
- Ability to mentor and support staff to meet business needs
Education:
- Associates Degree in Nursing required
- BSN preferred
Pay Range
The typical pay range for this role is:
$88,374.00 - $190,344.00
This 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 Benefits | CVS Health
We anticipate the application window for this opening will close on: 11/22/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.