Experienced Quality Management Nurse Associate LPN - Remote Opportunity for Clinical Excellence and Professional Growth in a Dynamic Healthcare Environment

Introduction to CVS Health and Our Mission At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle underscores our commitment to delivering human-centric healthcare that is both personal and innovative. As part of our team, you will be part of a culture that values the role each individual plays in transforming our approach to healthcare, making it more accessible, affordable, and tailored to the needs of our communities. Our Heart At Work Behaviors support this mission, empowering every team member to contribute to a culture of innovation and care. About the Position: Quality Management Nurse Associate LPN - Remote We are seeking a highly skilled and dedicated Quality Management Nurse Associate LPN to join our remote team. As a key member of our Quality Management: OD Correspondence team, you will play a vital role in reviewing and approving pre-service post-acute denial correspondence, ensuring that all communications meet CMS requirements and are member-friendly. This is a fast-paced environment that requires collaboration with RNs and Medical Directors to develop appropriate denial letter language, identify needs for standard denial language, and suggest options to close gaps, all while meeting TAT metrics. Key Responsibilities: Review and approve pre-service post-acute denial correspondence to ensure compliance with CMS requirements and member-friendly language. Collaborate with RNs and Medical Directors on denial letter language, focusing on clarity, compliance, and member-centric communication. Identify gaps in standard denial language and propose solutions to enhance our correspondence processes. Work effectively in a remote setting, utilizing digital tools and platforms to communicate and collaborate with the team. Contribute to the development of best practices in quality management, leveraging your clinical experience and knowledge of Medicare and managed care principles. Essential Qualifications To be successful in this role, you will need: An active, current, and unrestricted LPN/LVN licensure in your state of residence. At least 3 years of clinical experience, with a strong foundation in patient care and clinical decision-making. 3+ years of experience using personal computers, navigating multiple systems and applications, and proficiency in MS Office Suite applications (Teams, Outlook, Word, Excel, etc.). 1+ year of Medicare experience, with a solid understanding of CMS requirements and guidelines. The ability to work a fixed schedule, Monday through Friday, 11am - 7pm EST, with flexibility to adapt to the needs of a remote team environment. Preferred Qualifications While not required, the following qualifications are highly desirable: Managed care experience, with an understanding of utilization management, precertification, and quality management principles. Leadership experience, with a proven ability to guide teams or mentor colleagues in clinical or quality management settings. Utilization Management, Precertification, or Quality Management experience, demonstrating a deep understanding of healthcare operations and quality improvement initiatives. Education and Certification A high school diploma with LPN/LVN certification is required for this position. Your educational background, combined with your clinical experience and skills, will provide a solid foundation for success in this role. Compensation and Benefits The typical pay range for this role is $22.40 - $58.40 per hour, with the actual base salary offer depending on factors such as experience, education, and geography. Beyond your competitive compensation, you will enjoy a comprehensive benefits package that includes: Medical, dental, and vision benefits to support your health and wellbeing. Eligibility to enroll in the Company’s 401(k) retirement savings plan and an Employee Stock Purchase Plan. A fully-paid term life insurance plan and short-term and long-term disability benefits. Numerous well-being programs, education assistance, and free development courses to support your professional growth. A CVS store discount and discount programs with participating partners. Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year, consistent with state law and Company policies. Career Growth and Learning Opportunities At CVS Health, we are committed to the growth and development of our team members. As a Quality Management Nurse Associate LPN, you will have access to a range of learning opportunities, including: Professional development courses and training programs to enhance your clinical and quality management skills. Mentorship and guidance from experienced professionals in the field. Opportunities to contribute to quality improvement initiatives and shape the future of healthcare delivery. A culture that values innovation, creativity, and collaboration, providing a stimulating environment for professional growth. Work Environment and Company Culture Our remote work environment is designed to support flexibility, productivity, and collaboration. As part of our team, you will enjoy: The autonomy to work independently, with the support of a remote team and digital tools. A culture that prioritizes work-life balance, recognizing the importance of personal and professional wellbeing. Opportunities to engage with colleagues and contribute to a positive, inclusive work environment. A sense of purpose and fulfillment, knowing that your work is contributing to the health and wellbeing of our communities. Conclusion and Call to Action If you are a motivated and compassionate healthcare professional looking for a challenging and rewarding role, we encourage you to apply for the Quality Management Nurse Associate LPN position. With your clinical expertise, passion for quality management, and ability to thrive in a remote environment, you will be an invaluable asset to our team. Don’t miss this opportunity to join a dynamic and innovative healthcare organization and contribute to the future of healthcare. Apply today and take the first step towards a fulfilling and challenging career with CVS Health. Apply for this job