SNF Utilization Management RN - Compact Rqd
HumanaSalary not specified
Full Time
Mid-level (3 to 4 years), Senior (5 to 8 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- Registered Nurse with active and unrestricted license in state the candidate resides
- 4+ years of case management experience
- 3+ years clinical experience
- 1+ year leadership or supervisory experience
- Reside in the state of New York or New Jersey
- 4+ years of Outlook experience
- 4+ years of Microsoft PowerPoint experience
- 4+ years of Microsoft Excel experience
- 1+ years of SharePoint experience
Responsibilities
- Work with assigned Aetna Medicare Provider Collaboration groups to drive improved performance by leading clinical performance improvement projects and managing multiple complex deliverables through to implementation
- Establish trusting relationships with provider partners to promote open communication
- Serve as clinical expert on actionable opportunities related to CM, gap closure, workflow discussions, and partnering with case manager supervisor/manager and CMs
- Serve as internal and external liaison and clinical resource, interpreting data and educating regarding how to utilize data for PC performance improvement
- Strategize with SMEs and clinical teams both internally and externally to drive outcomes and improve efficiencies
- Coordinate and conduct clinically focused meetings to identify opportunities, target and prioritize goals and interventions to close gaps in care and achieve optimal stars performance
- Collaboratively work across multiple functions and/or segments to obtain agreement from all impacted parties (e.g., up and downstream effects often impact multiple functions and/or segments)
- Collaborate with Engagement Managers, Local Market Team, Data Team, Medical Operations and others on initiatives for Stars/quality improvement
Skills
Clinical Strategy
Population Health
Stars Performance
Quality Improvement
Case Management
Gap Closure
Workflow Optimization
Data Interpretation
Provider Collaboration
Project Management
CVS Health
Comprehensive pharmacy and healthcare services
About CVS Health
CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.
Woonsocket, Rhode IslandHeadquarters
1963Year Founded
DEBTCompany Stage
Healthcare, Consumer GoodsIndustries
10,001+Employees
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays
Risks
Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.
The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.
The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.
Differentiation
CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.
Upsides
Expansion of telehealth services allows CVS to reach more patients remotely.
Increased consumer interest in wellness boosts demand for CVS's health-related products.
The trend towards value-based care aligns with CVS's integrated healthcare approach.
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