CVS Health

Remote/Telecommute

Delegation Oversight Specialist - Nurse

Posted over 1 month ago

Job Description

Job Description
Candidate must be located in CA.

Schedule is Monday-Friday, standard business hours.

The Delegation Oversight Specialist - Nurse will be accountable for managing the development, implementation and ongoing maintenance of project(s) with relatively small and/or less complex scope and deliverables. Project scope typically impacts one of the following: process, system, function, and/or product. Length of project may run one year or less in duration. Project Manager that will be part of a team that oversees the following:

* Local committee structure and facilitation, to include Delegation Oversight Committee
* UM audits that fall outside pre-delegation review, annual audits and Corrective Action Plan (CAP) follow-up related to annual audits
* Scorecards/Dashboard reports, Notice of Action (NOA) denials reviews, performance tracking/trending, timeliness and accuracy and any additional delegation oversight deliverables needed to meet regulatory and/ or contractual requirements
* Relationship manager with delegates (Network)
* New delegate implementation (Network)
* State approvals for change in scope, termination, CAPS, etc.
* Plan level processes for monitoring/reporting state requirements for delegation oversight

Required Qualifications
- 3+ years of delegation oversight experience as it relates to utilization management required with an active CA RN licensure OR 5+ years of delegation oversight experience as it relates to utilization management with a CA LVN licensure.

Preferred Qualifications
- Experience with review of notice of action documentation
- Experience with quick turnaround times in UM prior authorization requirements
- Experience with UM audit at IPA or Plan level within Delegation Oversight
- Experience or understanding of MHC, DHCS, or other regulatory requirements
- 1 year(s) of project management experience preferred

Education
- Associate's degree or Nursing Diploma required
- Bachelor's degree preferred

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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