Associate Manager - Duals Prior Authorization

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 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 program design/product, Medical Directors, account teams/plan sponsor liaisons, etc.) to ensure consistency in clinical interventions supporting our members.The Associate Manager role includes (but is not limited to):

• 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 inter and intra-departmental 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

• Candidate must have active, current and unrestricted Registered Nurse (RN) Licensure in state of residence
• Must be able to work Monday - Friday 8:00 to 5:00pm EST
• Must be able to work occasional late week day and/or weekend coverage
• Must be able to work holiday coverage rotation per the needs of the department
• 3+ years clinical experience as a Registered Nurse
• 3+ years of managed care experience
• 1+ years of utilization management experience
• Ability to travel up to 5% for meetings/audits
• Must have Microsoft Office suites experience

• Experience with MedCompass
• 1+ year leadership experience (formal or informal roles)
• Ability to communicate effectively with providers, members, staff, and other leaders both in oral and written formats (exceptional communication skills)
• Ability to evaluate and interpret data, identifies areas of improvement
• Time efficient and highly organized
• Ability to mentor and support staff to meet business needs

• Associate's Degree in Nursing (REQUIRED)
• Bachelor's Degree in Nursing (PREFERRED)

• Candidate must have active, current and unrestricted Registered Nurse (RN) Licensure in state of residence

• 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.