A Brief Overview Designs and implements Clinical Health medical services, leveraging industry-proven procedures and best practices. Assists with clinical Health Service programs, procedures, and services.
What you will do
- Owns responsibility for the oversight of Integrated Care Management (ICM) and Long-Term Services and Supports (LTSS) healthcare case management staff, including progressing initiatives for high-performing health service teams.
- Works closely with functional Health Services managers in order to ensure ongoing consistency and accuracy in clinical interventions supporting current members.
- Takes accountability for completing tasks aimed to successfully achieve the financial, operational, and quality objectives of the work area.
- Functions as a key resource to healthcare members for governmental, state, local, and legal initiatives including the Consolidated Omnibus Budget Reconciliation Act (COBRA), Emergency Medical Treatment & Labor Act (EMTALA), and Medicare acts and regulations.
- Assists in implementing and sustaining action plans, initiatives, and strategies for Clinical Health Services policies and procedures.
- Provides application expertise to Health Services account managers as needed, to aid in the retention of existing clients by improving team member use of healthcare resources and tools.
- Partners with patient resources and divisional management, Clinical Education, and other key departments to assist in the evaluation of performance initiatives, subsequently recommending appropriate training to positively impact outcomes.
- Works to implement effective Clinical Health Services change management plans when new initiatives are rolled out or enhanced by upper management.
- Facilitates regular staff meetings to ensure all team members are fully versed on ongoing as well as new work area policies, procedures, and expectations.
Required Qualifications
- 5+ years clinical work experience
- Candidate must have active and unrestricted applicable license/certification and - specialized knowledge and expertise from entry to experienced level – Registered Nurse License (RN), Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC) in their state of residence
Preferred Qualifications
- Advanced problem solving and decision making skills
- Advanced knowledge of medical terminology
- Advanced collaboration and teamwork skills
- Advanced growth mindset skills (agility and developing yourself and others)
- Advanced skills in execution and delivery (planning, delivering, and supporting)
- Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option
- Advanced digital literacy skills
Education
- Associate's Degree (REQUIRED)
- Bachelor's Degree or Master's Degree (PREFERRED)
License
- Active and unrestricted Registered Nurse (RN) License, Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC) in their state of residence
Work from Home Requirements
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
- A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours 40
Time Type Full time
Pay Range
The typical pay range for this role is
$88,374.00 - $190,344.00