Job Description:

• Lead the day-to-day operations of a Medicaid Centralized Letters team
• Ensure accurate and timely delivery of member notification and authorization determination communications
• Ensure compliance with state contractual requirements, regulatory standards, accreditation requirements, and established turnaround times
• Monitor operational performance and analyze data to identify opportunities for process improvement, quality enhancement, and increased efficiency
• Partner with internal business partners, peer leaders, and external vendors to support effective execution of member communication processes
• Implement and monitor clinical policies, procedures, and operational practices in accordance with applicable state, federal, and accreditation requirements
• Support continuous improvement efforts by identifying and implementing best practices that improve service delivery and operational performance
• Manage a team of approximately 20 colleagues
• Develop high-performing teams and support strategic initiatives across the centralized letters organization

Requirements:

• Active, current, and unrestricted RN license in the state of residence
• 5 years relevant work experience
• 2+ years of managed care experience
• Demonstrated leadership experience in a Team Lead, Supervisor, or higher-level leadership role
• Proficiency with Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint
• Ability to work core business hours, Monday through Friday, 8:00 AM to 5:00 PM, with flexibility to work occasional weekends as business needs require
• Ability to work beyond regularly scheduled hours as needed to meet business objectives
• Ability to travel up to 5% for meetings, audits, and implementation activities
• Experience with Utilization Management and prior authorization processes
• Experience working with state contractual requirements, regulatory guidelines, and member notification compliance within a managed care environment
• Experience with NCQA standards and accreditation requirements
• Experience partnering with external vendors to support operational objectives
• Ability to work independently in a remote environment while effectively collaborating with virtual teams
• Master’s degree or equivalent clinical experience
• If candidate has associate’s degree, additional 4 years of experience is needed
• If candidate has bachelor’s degree, an additional 2 years of experience is required

Benefits:

• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being