Associate Manager, Clinical Health Services – Utilization Management (Remote)

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company 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 reputed company/reputed company, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care reputed company that promote high-quality healthcare for members. Position Summary The Associate Manager is responsible for reputed company 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 (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 reputed company address the member's and provider’s needs across the continuum of care
• May act as a liaison with other key business areas.
• May reputed company/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 reputed company of contact for the customer and the Account Team including participation in customer meetings, implementation and reputed company 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 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 reputed company change efforts
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, reputed company 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 reputed company care responsibilities during shift times are not permitted.

Required Qualifications

• Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.
• 5+ years of acute experience as a Registered Nurse
• 3+ years of Utilization Management experience
• 3+ year(s) of Appeals experience in Utilization Management
• Must have experience using MS Office
• Must be willing to work holiday rotation annually, up to 2 per year
• Utilization Management work schedules will include weekends, holidays, and evening hours rotation.

Preferred Qualifications

• Prior leadership experience
• Ability to evaluate and interpret data, identifies areas of improvement

Education

• Associate's degree in nursing (RN) required, BSN 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 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. 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 reputed company 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 10/14/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job