Associate Manager, Clinical Health Services - Fully Remote

Job Opportunity At Cvs Health

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. This is a remote work from home role anywhere in the US with virtual training. Shift schedule is 8 : 30am - 5pm within time zone of residence.

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna / Cvs Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. This position consists of working intensely as a telephonic Associate Manager, Case Management with staff and clients for fully and / or self-insured clients. Supervision of Case Managers who assess patient needs, evaluate plan of care, monitor effectiveness of care, communicate case objectives and act as patient advocate. Act as a resource for the Case Managers and support staff. Maintain a focus on timely customer service for internal and external clients. Establish professional working relationships with all members of the interdisciplinary team and communicate case objectives to the appropriate involved parties. Coach and utilize creative strategies that will allow all staff to become better case managers. Willingness to volunteer and lead committees, share insights, offer innovative solutions and evaluate outcomes. Resolve staff issues and communicate information appropriately to the Manager of Case Management. Refer all cases that do not meet applicable criteria or have a potential quality of care issue to a physician reviewer. Identify and address quality issues and participates in quality management activities. Assist in the preparation of reports that analyze and track quality of service and utilization statistics. Comply with policies and procedures and conforms to URAC standards while performing the job functions.

Required Qualifications

5+ years' experience as a Registered Nurse with hospital experience; preferably in the specialty. A Registered Nurse that holds an unrestricted license in their state of residence, with multi-state / compact privileges or can be licensed in all non-compact states. 1+ years' of case management experience. Certified Case Manager (CCM) or obtains CCM within 3 years of becoming a supervisor.

Preferred Qualifications

Supervisor / Management experience. Experience with MCG, NCCN and / or Lexicomp. Experience with MS Office products.

Education

Registered Nurse Diploma or Associates required. Bachelors preferred.

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $72,306.00 - $207,648.00

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 people. We 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.

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.