QA & Training Manager responsible for quality assurance and training for U.S. healthcare accounts in the Philippines. Leading operational support and client engagement for contact center and claims adjudication teams.
About the role
- Registered Nurse Case Manager for CVS Health implementing care strategies in New Jersey. Conducting assessments and coordinating interdisciplinary team meetings for high-quality member care.
Responsibilities
- Conduct in-home, face-to-face assessments using comprehensive tools for members enrolled in Managed Long-Term Services and Supports (MLTSS) and/or Dual Special Needs Programs (D-SNP/FIDE)
- Evaluate non-MLTSS members for service eligibility and support needs, including adult/pediatric medical daycare, personal care assistants, nursing facility services, and MLTSS enrollment
- Collaborate with members, their representatives, primary care providers, and interdisciplinary care teams to develop and implement individualized care plans
- Attend and coordinate interdisciplinary team meetings, advocating for members to ensure safe and appropriate service delivery and discharge planning
- Authorize services within program benefits in a cost-effective manner
- Accurately and promptly document all activities in the electronic health record
- Mentor new hires upon achieving proficiency in the role
Requirements
- Active, unrestricted Registered Nurse (RN) license in New Jersey
- Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care
- Willingness and ability to travel 50–75% within New Jersey
- Must possess reliable transportation and be willing and able to travel up to 75% of the time
- Successful completion of the NJ Choice Certification, including: A minimum score of 80% on the exam
- Technical skills: Proficient in Multisystem Navigation, Effective Multitasker, Basic Technical Troubleshooting, Digital Collaboration & Documentation, Highly Organized & Results-Oriented, Metric-Driven Performance, Clean & Efficient Workspace Management
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation, and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access and many other benefits depending on eligibility
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