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
Multifunctional project manager who will use critical thinking skills to review and implement State and Federal Regulations, develop, and implement strategies to support Legislative and Regulatory changes.Fundamental components include but are not limited to:
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This position is part of the UM COE, a team that is responsible for Clinical Services utilization management and specialty program policies/procedures. Primary responsibilities of this position include:
The review and implementation of State and Federal Regulations.
Review of policy, job aids and workflows that support regulatory requests, drafting/leading implementation of regulatory changes.Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies,
and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.Develop and implement strategy for policy/program development that considers all involved areas (e.g., systems, actuarial, marketing, etc.) and the potential impact on all managed care products.Operationalize strategy by prioritizing projects, designing programs and developing policies.Identify and involve appropriate subject matter experts (those who will operationalize programs).Design/manage implementation including business processes, system and other modifications.Design and manage communications and training.Analyze ongoing performance data and utilize to initiate/ implement changes
Required Qualifications
3+ years minimum of utilization management- Clinical Operations experience
Project Management CertificationPreferred Qualifications
Knowledge of Commercial, Medicare, Medicaid, Duals LOB
RN license preferredEducation
Bachelor's degree or equivalent experience.Pay Range
The typical pay range for this role is:$66,330.00 - $145,860.00This 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: 02/22/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.