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Job Description
This is a full-time telework role with up to 10% travel required for meetings, as needed.
Candidates must be located in the state of Kentucky or within 45 minutes traveling distance. Candidate must be willing to work the majority of working hours Monday-Friday, standard business hours EST or CST with occasional weekend on call.
Utilization Management Nurse Supervisor Oversees the implementation of healthcare management services for utilization management. Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. CMS, NCQA, and state and federal standards and mandates. • 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 • Responsible for monitoring and reinforcing UM processes related to prior authorization and concurrent medical necessity reviews. • Communicate performance expectations Ensures the team’s understanding and use of information system capability and functionality • May act as a single point of contact for internal/external stakeholders. • 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 and collaboration 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
Pay Range
The typical pay range for this role is:
Minimum: 82,000
Maximum: 176,800
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
RN license for state of Kentucky
Must reside in the state of Kentucky or within 45 minute travel distance.
5+ years in Managed Care environment
Schedule is Monday- Friday 8a-5p with occasional weekend on call
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
BSN preferred
3+ years in Utilization Management Preferred
Management experience Preferred
8+ years Managed Care experience
Education
RN, BSN 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.
