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Posting Title Training and Quality Clinician RN

Job Grade 207

Position Summary :

This position is telework anywhere in the US.Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

The Training & Quality Clinician will support the training and compliance monitoring of the DSNP Care Management team. They are responsible for conducting audits of current processes, reports, and procedures to identify process improvements and issue resolutions.

• Develops and conducts ongoing staff training via educational notes based on workflow needs and outcomes of clinical audits.

• Provides ongoing and random qualitative and quantitative analysis using organizational performance measurements to ensure compliance with government regulations and corporate policy.

• Tracks and trends audit results, providing feedback to management.

• TQC clinician will support the DSNP markets. They are responsible for conducting audits of current processes and procedures to identify process improvements and issue resolutions.

• This is an audit position on the DSNP TQC audit team.

Required Qualifications :

• 3+ years of experience in a managed care clinical operation environment (utilization management, case management, and/or behavioral health case management) required.

• Unrestricted RN licensure required

• 1+ years Med Compass knowledge/experience required

• 1+ years DSNP experience required

Preferred Qualifications :

• Previous Managed Care experience

• Excellent verbal and written communication skills and attention to detail.

• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually

• Ability to use standard corporate software packages and corporate applications.

Education :

• Associates degree or RN Diploma required, BSN 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: 05/06/2024

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.