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　　Position Summary

　　The Medicare Compliance Nurse will be responsible compliance oversight of utilization management and HEDIS activities to ensure adherence to policies, procedures, and regulations. In this role they will support Medicare Compliance initiatives to ensure the seven (7) elements of an effective compliance program as described in CMS’ Compliance Program Guidelines (Chapters 9 and 21) and other applicable regulations are met. This individual has well developed knowledge and skills in areas of Utilization Management (UM), Quality Management, Medical Necessity and HEDIS requirements.

　　A successful candidate will have the ability to:

　　Work independently, as well as in collaboration with, colleagues from across the organization to monitor compliance strategies.

　　Work closely with business to understand CMS program audit requirements

　　Understands and can support the principles of an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training.

　　Independently identify and assess moderately complex compliance issues, communicate (oral or written) with executive leaders and others to discuss, and collaborate towards resolving the identified compliance issues.

　　Manage multiple projects simultaneously, displaying strong organizational skills.

　　Escalate risks and identified issues timely to leadership and work towards meaningful solutions.

　　Required Qualifications-Active LPN or RN License or 10+ years of Medicare Utilization Management experience

　　-5+ years of experience in Managed Care and Utilization ManagementPreferred Qualifications

　　Bachelor of Science in Nursing

　　10+ years in Medicare Compliance with UM experienceEducationLPN or RN certification with an associates degree, or a Bachelor of Science in Nursing degree, or equivalent years of experience.

　　Pay Range

　　The typical pay range for this role is:

　　$60,300.00 - $132,600.00

　　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

　　CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

　　You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.