CVS Health

Compensation

Full Description

Description: • Multifunctional program manager to review, assess impact and implement State and Federal Regulations • Work with legal, compliance and utilization management stakeholders to support legal mandate/compliance changes & audits • Provide consultative support & clarification of implemented mandates and ensure documents are current and accurate • Part of the Utilization Management Center of Excellence responsible for Clinical Services utilization management and specialty program policies/procedures • Review and implement regulations across all lines of business (Commercial, Medicare, Medicaid) • Review policy, job aids and workflows; draft and lead implementation of regulatory changes • Develop and implement strategy for policy/program development considering systems, actuarial, marketing and impacts on managed care products • Operationalize strategy: prioritize projects, design programs, develop policies, involve SMEs, design/manage implementation, communications and training • Analyze ongoing performance data and initiate/implement changes Requirements: • 3+ years minimum of utilization management - Clinical Operations experience • 3+ Experience & knowledge of Medicare & CMS compliance • 3+ Experience in implementing new programs/changes in UM space • Knowledge of Commercial, Medicare, Medicaid, Duals LOB (preferred) • RN license preferred • PMP Certification (preferred) • Bachelor's degree or equivalent experience Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) and an employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility • For more information, visit https://jobs.cvshealth.com/us/en/benefits