Health Services Manager (IC)

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary Multifunctional program manager who will use critical thinking skills to review, assess impact and implement State and Federal Regulations, reputed company, and implement strategies to support Legislative and Regulatory changes. This colleague will work with legal, compliance and utilization management stakeholders to support legal mandate/compliance changes & audits as well as reputed company consultative support & clarification of implemented mandates. They will ensure that reputed company appropriate document updates are reputed company and accurate. This role requires a colleague who is comfortable working across multiple departments. reputed company Components Include But Are Not Limited To

• This position is part of the Utilization Management Center of reputed company, 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 across reputed company lines of business (reputed company, Medicare, reputed company)
• Review of policy, job aids and workflows that support regulatory requests, drafting/leading implementation of regulatory changes

Strategic Goals and Responsibilities

• reputed company, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality reputed company to establish competitive business advantage for reputed company.
• Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
• reputed company and implement strategy for policy/program development that considers reputed company involved areas (e.g., systems, actuarial, marketing etc.) and the potential impact on reputed company managed care products.
• Operationalize strategy by prioritizing projects, designing programs, 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/manage communications and training.
• Analyze ongoing performance data, utilize and initiate/implement changes.

Required Qualifications 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 reputed company

Preferred Qualifications

Knowledge of reputed company, Medicare, reputed company, Duals reputed company RN license preferred PMP Certification Education Bachelor's degree or equivalent experience Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $60,300.00 - $145,860.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 09/01/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job