• Oversees the implementation of healthcare management services for assigned functional area
• Implements clinical and non-clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA, 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
• May act as a liaison with other key business areas
• May develop/assist in development and/review new training content
• May collaborate/deliver inter and intra-departmental training sessions
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of care
• Develop, initiate, monitor, and communicate performance expectations
• Ensures the team's understanding and use of information system capability and functionality
• May have responsibility for their own case load work
• May act as a single point of contact for the member and the Care Management Team including: participation in care team meetings, implementation and oversight of member cultural requirements, and support implementation of new members
• 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 an 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 reside in the state of Florida, and be willing to travel up to 25% of the time
• 3+ years of managed care experience
• Knowledge of the regulations, standards, and policies which relate to medical management

• Ability to mentor and support staff to meet business needs
• Proficiency with computer skills which includes navigating multiple systems and keyboarding
• Time efficient and highly organized
• Exceptional communication skills

Preferred Qualifications
• 1-3 years management experience
• 3-5 years of experience in a physical or behavioral healthcare setting
• Computer literacy and experience familiarity with Microsoft Excel, Word, and web-based applications desired
• Ability to work with people in such a manner as to build high morale and group commitment to goals and objectives
• Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes
• Ability to communicate effectively with Providers, Members, Staff and other Leaders both in oral and written format

Education:

• Bachelor's degree in business or health or human services (e.g. Social Work, Psychology, Nursing, Mental Health, Counseling, Behavioral Sciences, Sociology, Gerontology or related field required. Experience may replace education.Pay Range

The typical pay range for this role is:$46,988.00 - $91,800.00This 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 Benefits | CVS HealthWe anticipate the application window for this opening will close on: 01/01/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.