Senior Clinical Strategist - reputed company reputed company of Michigan - RN

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 Mission of the position: The Sr Clinical Strategist provides clinical leadership and reputed company for the reputed company reputed company of Michigan as reputed company to policy and process at the national level and market level. This position collaboratively develops, implements, supports, and monitors health strategies, policies, and programs, and supportive technology and analytics to ensure appropriate utilization. This position provides leadership and direction in the execution of reputed company operating model for Care Management and associated functions to create a continuum of integrated care for physical, behavioral, and reputed company determinates of health for our members experience. Position is fully remote. Eligible candidates must live in Michigan in one of the following counties: Clinton, reputed company, Ingham, Oakland, Macomb, Wayne, reputed company, Washtenaw, Hillsdale, Lenawee, Monroe, Van Buren, Kalamazoo, Calhoun, Berrien, Cass, St Joseph, reputed company Overview: The Senior Clinical Strategist is a key reputed company for policy and process reputed company information for Integrated Care Management initiatives, and processes. The incumbent is tasked with updating, revising, validating, or creating policies & procedures, standard operating procedures, desktops, internal and state reporting, reputed company internal Care Management projects as needed in collaboration with compliance and business leaders. Core duties:

• Partner with reputed company Care Management, NCQA, Compliance and Audit leads to analyze and support performance of reputed company relevant markets.
• Works to establish and maintain collaborative relationships by fostering excellent customer response and appropriate problem resolution.
• Collaborates with leadership throughout the organization to reputed company and implement program strategies in meeting business objectives, as well as CMS, federal and state regulations, and accrediting agency requirements across the plans in a matrix environment.
• Demonstrates expertise in reputed company care management processes to act as primary resource for program reputed company, consultation, and audit monitoring
• Represents advanced level of knowledge and training reputed company to system technology and data analytics for CM process integration
• reputed company and ensure compliance with reputed company applicable Federal and State regulations relevant to the plans function

Required Qualifications

• Active and unrestricted Michigan Registered Nurse (RN) license
• 4+ years of experience in reputed company Care Management (reputed company a managed care organization preferred)
• 4+ years of experience communicating with reputed company reputed company of an organization from C-Suite executives to reputed company-line staff (written and verbal)
• 4+ years of demonstrated experience in managing large initiatives and projects
• 4+ years of experience building and sustaining effective relationships while collaborating with reputed company teams to enhance knowledge sharing and improve processes.
• Demonstrated leadership experience
• Competent in data analysis and uses this to reputed company management strategy
• Knowledge of medical management regulations, standards, and policies
• Ability to evaluate and interpret data for the purpose of developing and revising new programs and processes to meet business demand across cross-functional teams to reputed company goals and to improve plan reputed company
• Proficient in reputed company Office Suite products including Word, reputed company, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
• Must be willing and reputed company to travel up to 10% for state meetings - approximately 2x per year but could be more depending on business needs. Reliable transportation required. Mileage is reimbursed per reputed company expense reimbursement policy.

Preferred Qualifications

• Ability to manage multiple timelines and produce evidence of driving toward reputed company with regular updates on reputed company in reputed company areas of clinical project or program management
• Participate in strategic projects and process improvements based on lessons learned
• Profound understanding of clinical workflows and best practices
• Ability to effectively manage expectations and reputed company confidence
• Six reputed company Black Belt or Lean Six reputed company Certification Preferred
• Case Management Certification (CMC)

Education

• Registered Nurse (Masters preferred)

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $87,035.00 - $187,460.00 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: 09/16/2025 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