Associate Manager, Clinical Health Services – Utilization Management (Remote)
Position Information
Schedule: Monday–Friday 8:00am-5:00pm EST (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 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 develops and monitors high-performing teams, working closely with functional area leadership, medical directors, and other stakeholders to ensure consistency in clinical interventions supporting our members.
Key Responsibilities
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 and procedures in accordance with applicable regulatory and accreditation standards (e.g., NCQA, URAC, state and federal standards).
Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution, and critical thinking.
Ensures implementation and monitoring of best practice approaches and innovations to better address member needs across the continuum of care.
Drives operational excellence by streamlining processes and workflows, leveraging technology to simplify operations.
May act as a liaison with other key business areas.
May develop or review new training content.
May collaborate and deliver interdepartmental training sessions.
Protects 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 and support of new customers.
Participates in the recruitment and hiring process for staff using clearly defined requirements.
Assesses developmental needs and collaborates with others to implement action plans that support high-performing teams.
Establishes an environment that promotes teamwork, cross-product integration, and continuum of care thinking.
Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
Creates a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance when needed.
Maintains compliance with policies and procedures at the employee level.
Participates in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.
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
Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.
3+ years of inpatient clinical experience as a Registered Nurse.
3+ years of Managed Care experience.
3+ years of Utilization Management experience.
1+ year Leadership experience (formal or informal).
1+ year of MS Office suite experience.
Preferred Qualifications
Experience with multiple clinical systems.
Strong communication skills with Providers, Members, Staff, and other Leaders.
Ability to evaluate and interpret data, identifying areas of improvement.
Time efficient and highly organized.
Exceptional communication skills.
Ability to mentor and support staff to meet business needs.
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 - $155,736.00. 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 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.
Great Benefits For Great People
Affordable medical plan options, 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No-cost programs for all colleagues including wellness screenings, tobacco cessation, weight management, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of 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.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Job Details
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care
We anticipate the application window for this opening will close on: 11/10/2025.