Log In
Sign Up
Job Description
This position is a fully remote position. It is open to candidates residing anywhere in US. It requires working on EST.
Standard working hours of Monday – Friday 8am -5pm EST but occasionally may require to work beyond standard working hours to meet critical business needs.
Responsible to oversee the daily workload of various team members (RN clinicians, authorization specialists and inbound/outbound queue associates)
Monitors the team productivity monthly and ensures efficient workflows are utilized to optimize performance
Aggregates the compliance data monthly and reports at leadership level
Is considered a subject matter expert in Utilization Management and shares cutting edge clinical information with internal and external teams
Able to multi-task and orchestrate simultaneous projects to ensure departmental deadlines are met
Reviews policies and updates departmental UM procedures as needed
Supervising the day to day operations for the UM team.
Monitoring the performance of Authorization team and ensures compliance with critical turn around times associated with UM processes.
Must be detail oriented and process driven
Maintains accurate compliance reports
Required Qualifications
- Active and unrestricted RN License in the state of NY required.
- Minimum 2 years of Utilization Management Experience required.
- Minimum 1 year of MS office experience.
- Minimum 1 year of experience in applying Milliman Guidelines and medical necessity guidelines to member requests
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications
- Experience in Managed Long Term Care ( MLTC) experience highly preferred.
- 3 or more years of supervisory experience of personnel is highly preferred.
Education
Minimum Bachelors Degree
Masters degree preferred
Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
