Associate Manager, Clinical Health Services Utilization Management (Remote)

Associate Manager

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.

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

The 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 Responsibilities

• Accountable 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 area.
• Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards.
• 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 and provider's needs across the continuum of care.
• 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.
• Manages 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 care.
• 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.
• Assess developmental needs and collaborate 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 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.

Remote 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 Qualifications

Preferred Qualifications

Education

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

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

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 :