Associate Manager, Prior Authorization

Associate Manager, Clinical Health Services (Prior Authorization)

The Associate Manager, Clinical Health Services (Prior Authorization) is responsible for oversight of healthcare staff, including the organization and development of high performing teams. This person works closely with functional area management to ensure consistency in clinical interventions supporting our members. They will be accountable for meeting the financial, operational and quality objectives of the unit.

In this role, you will :

• Be accountable for meeting the financial, operational, and quality objectives of the unit.
• Ensure team maintains compliance and privacy practices.
• Oversee the implementation of utilization management services for assigned area.
• Implement 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 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.
• Protect the confidentiality of member information and adhere to company policies regarding confidentiality.
• Manage 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.
• Ensure the team's understanding and use of information system capability and functionality.
• May act as a single point of contact for the customer and 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, and technical & performance skills.
• Assess developmental needs and collaborate with others, in order 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 demonstrate 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; implement them at the employee level.

Required Qualifications :

Preferred Qualifications :

Education :

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is $80,340.00 - $173,040.00. This 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.

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 :