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. **Position Summary** How will this role have an impact? Signify Health formed internal clinical compliance team and is excited for this role to help develop clinical quality and compliance and ensure our members receive the best possible care. The RN Clinical Compliance Specialist will assist the team with maintaining policies and processes related to clinical compliance. This role will be responsible for daily operations of the Signify HCS clinical compliance program, as well as any ad hoc regulatory research and analysis as needed. This role will also be responsible for conducting, monitoring, and investigating functions related to clinical compliance driven by member compliance, compliance concerns and member amendment requests. This role will report to our Manager, Clinical Compliance. What will you do? ○ Conduct audits, including collecting, monitoring and analyzing data. ○ Lead clinical compliance investigations, which will require respectful and confidential investigative techniques. Apply clinical knowledge to gather, collate, and interpret data findings and appropriate next steps. ○ Communicate effectively the findings of confidential investigations to appropriate leadership. ○ Support and maintain clinical compliance policies, procedures and processes at direction of manager and or leadership. ○ Collaborate effectively within a team environment, contributing to team goals and supporting team members as needed ○ Provide support to office of CMO and Clinical Success team ○ Research clinical compliance best practices and any regulatory requirements as needed. ○ Review member amendment requests and present findings to the CMO with recommendations for next steps. ○ Other duties as assigned **Required Qualifications** We are looking for a candidate with the following skills/credentials/characteristics: ● Ethical conduct ● RN degree required (associate or bachelors) ● Intermediate Excel experience preferred. ● 3+ years experience in an health care setting, some experience with clinical coding guidelines preferred ● Self-motivated who will take the initiative to learn new programs, policies and skills ● Self-directed, independent performer, able to act independently and manage day to day objectives ● Ability to work in a fast-paced environment with rapidly changing priorities ● Demonstrates flexibility and a positive attitude ● Able to read, analyze and interpret business, professional, technical or governmental documents. ● Ability to write reports, business correspondence and procedure manuals. ● Able to effectively present information and respond to questions from managers, customers and the public. ● Add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Compute rate, ratio and percent, and draw and interpret bar graphs. ● Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. ● Interpret a variety of instructions furnished in written, oral, diagram, or schedule form. ● Proficient in Microsoft Suite and Learning Management Systems. Deep knowledge of presentation software. **Preferred Qualifications** Prior workflow experience Intermediate Excel experience **Education** Associates or Bachelors in Nursing **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $60,522.00 - $129,615.00 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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits) We anticipate the application window for this opening will close on: 02/21/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. 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.