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Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Approximately 10% of travel required within the state of Virginia. Must reside in state of Virginia, preferably in the Central Region.

Position SummaryResponsible for the review and evaluation of clinical information and documentation to determine if the plan is person-centered, based on the assessment, and whether it addresses the individual’s needs and personal goals. Reviews documentation and interprets data obtained from clinical records or systems to monitor and evaluate DMAS Home Community Based Services (HCBS) waivers and program participation requirements. Coordinates and conducts exit interviews/conferences with providers and educates them on specific waivers and other audit requirements. Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines, and maximize compliance with Virginia Medicaid Waiver Programs. Implements corrective action plans (CAPs), provision of technical assistance, and referrals to the Department of Program Integrity when applicable and follows up on CAPs to ensure compliance. Pro-actively and consistently applies waiver program requirements, accreditation standards, and HEDIS specifications to assure that activities are processed within guidelines. Condenses complex information into a clear and precise clinical picture, while working independently. Reports audit or clinical findings timely to appropriate staff or others to ensure appropriate outcome and/or follow-up improvement as indicated.

Required Qualifications

• 3+ years of clinical experience required

• 3+ years of Quality experience required

• Virginia resident required

• Licensed RN with current unrestricted state of Virginia licensure required

• Must possess reliable transportation and be willing and able to travel approximately 10% of the time. Mileage is reimbursed per our company expense reimbursement policy

• 1+ year of experience using Microsoft Excel

Preferred Qualifications - Managed Care and HEDIS experience preferred

Education

• Associates degree minimum required

• Bachelor’s degree preferred

Pay Range

The typical pay range for this role is:

$60,522.80 - $129,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 06/17/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.