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 Information

Schedule: 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 Us

American 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 Summary

• Accountable for meeting the financial, operational, and quality objectives of the unit.
• Oversees the implementation of healthcare management services for assigned functional area
• Implements 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 thinking
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
• Drive operational excellence by streamlining processes and workflows to drive efficiencies, leveraging technology to streamline and simplify
• May act as a liaison with other key business areas.
• May develop/assist in development and/review new training content
• May collaborate/deliver interdepartmental training sessions
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• May collaborate with leadership for the development of, monitoring and communicating performance expectations
• Ensures the team's understanding and use of information system capability and functionality
• May 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 skills
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams
• Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level
• Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.

• 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.

• Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.
• 3+ years inpatient clinical experience as a Registered Nurse.
• 3+ years of Managed Care experience.
• 3+ years of Utilization Management experience.
• 1+ year Leadership experience (formal or informal roles).
• 1+ years of MS office suite experience.

• Experience with multiple clinical systems.
• Utilization Management experience.
• Ability to communicate effectively with Providers, Members, Staff, and other Leaders both in oral and written formats.
• Ability to evaluate and interpret data, identifies areas of improvement.
• Time efficient and highly organized.
• Exceptional communication skills.
• Ability to mentor and support staff to meet business needs.

• Associate's degree in nursing (RN) required, BSN preferred.

• 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.