CVS Health logo
CVS Health

CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca

RN Manager – Delegation Compliance

Location

Illinois

Posted

11 hours ago

Salary

$88.4K - $190.3K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

RN Manager – Delegation Compliance

CVS Health

• Oversee compliance for UM and CM to deliver an unmatched patient experience and ensure delegation compliance. • Audit individual charts according to QA Audit Protocols to ensure compliance with program responsibilities and best practices. • Possess knowledge of contractual, accreditation, federal and business requirements for assigned program and ensure compliance with program requirements and develop corrective action plans as needed. • Establish work procedures and processes that support the company and departmental standards, procedures and strategic directives. • Establish workflows that meet compliance requirements and align with organization-wide clinical protocols. • Lead the review of policies and procedures, program descriptions, and evaluations. • Conduct training for new team members and other internal parties as required. • Provide statistical and performance feedback, and coaching on a regular basis to each team member in their assigned region. • Create and maintain a high-quality work environment so team members are motivated to perform at their highest level. • Provide continual evaluation of processes and procedures. • Responsible for suggesting methods to improve area operations, efficiency, and service to both internal and external staff. • Collaborate with other OSH program leaders to implement initiatives in support of integrating delegated services with core OSH care model.

Job Requirements

  • Bachelor’s in Nursing
  • Active RN license within one or more OSH states
  • Willingness to obtain cross-state licensure, as needed
  • 5+ years of healthcare experience, preferably in a primary care and/or managed care setting
  • 2+ years direct supervisory experience
  • Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
  • Knowledge of Medicare/Medicaid and NCQA requirements
  • Practical and operational experience in a managed care environment, preferably with working knowledge of related legal/regulatory/health plan requirements
  • Demonstrated experience leading teams, competence with change management, and leading process improvement
  • Knowledge relating to healthcare delivery workflows, project management, and quality improvement is required
  • Prior experience in a similar role at an IPA, Health Plan or MSO will be advantageous
  • Strong teamwork and interpersonal skills
  • Proficient with Microsoft Office, Google Suite, and healthcare EMRs

Benefits

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • comprehensive benefits package designed to support physical, emotional, and financial well-being

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