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SalaryStandard business hours Monday-Friday.
Work at home with approximately 25% of travel around Southeast Michigan. Requirement to reside in the Southeast Michigan area and commutable to Southfield, MI.
Responsible for the review and evaluation of clinical information and documentation. Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Independently coordinates the clinical resolution with internal/external clinician support as required. Will provide committee, delegation, and Performance Improvement Plan support.
Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
Preferred Qualifications
Education
Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. 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.
Work at home with approximately 25% of travel around Southeast Michigan. Requirement to reside in the Southeast Michigan area and commutable to Southfield, MI.
- Policy review and update
- Provider outreach
- Medical record review and support
- Quality management
- NCQA accreditation coordination
Responsible for the review and evaluation of clinical information and documentation. Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Independently coordinates the clinical resolution with internal/external clinician support as required. Will provide committee, delegation, and Performance Improvement Plan support.
Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications
- An active and good standing Michigan RN license required
- 3+ years of clinical experience
Preferred Qualifications
- Previous performance improvement plan experience
- NCQA experience
- Managed care experience
Education
- Bachelor degree preferred
- Associate's degree minimum
Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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. 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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