Health Services Manager - RN LPN MA Coder

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Manager, Health Services is a key member of the Medical Policy & Program Solutions Team. The Manager influences health care quality projects and initiatives through design, development, and implementation. These activities enable Aetna to improve health care quality products, services, and processes by partnering across business units to meet business needs and accomplish goals.

This is a fully remote position. Eligible candidates may live anywhere in the contiguous United States.

• Leads the work and deliverables of multiple, complex programs, and supports new business initiatives, that impact multiple process, systems, functions, and products related to authorizations services.

• Develops and implements business plans to achieve business goals for Medical Policy & Program Solutions.

• Collaborates and partners with other functional managers, other business areas/across the segments or other business areas.

• Develops and implements innovative ideas that support work/teams.

• Assists others to identify solutions to issues that negatively impact program and/or project plan.

• Leads and supports scorable action items across Commercial, Medicare and/or nationally.

• Develops documentation templates and systems to support projects and initiatives.

Required Qualifications

• Certified Professional Coder through AAPC or AHIMA (Physician, Facility or Payer) a plus or willing to pursue within two years.

• Knowledge of healthcare insurance and industry standards to include Medicare and Medicaid

• Minimum 3 years' Commercial, Medicare, and experience to include understanding of compliance regulations for Medicare

• Experience and participation in Commercial, Medicare, and internal audits and/or CMS audits – for example questions regarding incorrectly paid claims

• Proficiency in Microsoft Excel, Word, and Power Point

Preferred Qualifications

• Code editing and quality review experience related to payment policies, projects and programs. 

• Clinical experience as an RN or LPN

• Experience with QuickBase applications

• ACAS and/or HRP Claim review and expertise

• Project management experience a plus or experience managing internal projects

Education

• Associate's or bachelor’s degree in healthcare management or equivalent managed care experience in the healthcare industry

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.   

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.