Associate Manager, Clinical Health Services Utilization Management (Remote)

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position InformationSchedule: Monday-Friday 8:00am-5:00pm EST Hours (Shift times may vary based on business needs)Travel Required up to 5% for meetings/audits.Location: 100% Remote (U.S. only)About UsAmerican Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.Position SummaryThe Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and monitoring of high performing teams. Works closely with functional area leadership team (department Associate Managers, Manager, and other key stakeholders such as Medical Directors, account teams/clinical liaisons, etc.) to ensure consistency in clinical interventions supporting our members.Key ResponsibilitiesAccountable for meeting the financial, operational and quality objectives of the unit.Ensures team maintains compliance and privacy practices.Oversees the implementation of utilization management services for assigned areaImplements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards and mandates as applicable)Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinkingEnsure implementation and monitoring of best practice approaches and innovations to better address the member's and provider's needs across the continuum of careMay act as a liaison with other key business areas.May develop/assist in development and/review new training content.May collaborate/deliver inter and intra-departmental training sessionsProtects the confidentiality of member information and adheres to company policies regarding confidentialityManages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating, and documenting of careMay collaborate with leadership for the development of, monitoring and communicating performance expectationsEnsures the team's understanding and use of information system capability and functionalityMay act as a single point of contact for the customer and the Account Team including participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skillsAssesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams and on-purpose culture.Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performanceConsistently demonstrates the ability to serve as a model change agent and lead change effortsCreate a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when neededAccountable for maintaining compliance with policies and procedures and implements them at the employee levelRemote Work Expectations This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.Required QualificationsActive, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.5+ years of acute experience as a Registered Nurse3+ years of Utilization Management experience3+ year(s) of Appeals experience in Utilization ManagementMust have experience using MS OfficeMust be willing to work holiday rotation annually, up to 2 per yearUtilization Management work schedules will include weekends, holidays, and evening hours rotation.Preferred QualificationsPrior leadership experienceAbility to evaluate and interpret data, identifies areas of improvementEducation Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40Time TypeFull timePay RangeThe typical pay range for this role is:$72,306.00 - $207,648.00This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including 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.For more information, visit anticipate the application window for this opening will close on: 10/21/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job