Position Summary
CVS Health is seeking an Associate Manager, Utilization Management (RN) to oversee and develop a high-performing team of UM staff. This role focuses on ensuring clinical quality, compliance with regulatory standards, and operational excellence. You’ll provide leadership, serve as a mentor, and collaborate with cross-functional teams to improve care management solutions for our members.
Key Responsibilities
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Lead Utilization Management staff to achieve financial, operational, and quality goals.
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Oversee implementation of UM services aligned with NCQA, URAC, and state/federal standards.
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Mentor teams on clinical practice standards, problem-solving, and critical thinking.
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Ensure best practice adoption to support members and providers across the care continuum.
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Support recruitment, training, and development of staff.
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Act as liaison with customers, account teams, and leadership.
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Promote teamwork, cross-functional collaboration, and a positive culture.
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Ensure compliance with confidentiality, privacy, and company policies.
Required Qualifications
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Active, unrestricted RN license (compact/multistate preferred); ability to obtain other state licenses.
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5+ years of acute RN experience.
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3+ years of Utilization Management experience.
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Proficiency in MS Office.
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Flexibility to work holiday rotation (up to 2 annually), plus weekend/evening shifts as needed.
Preferred Qualifications:
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Prior leadership experience.
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Strong skills in data evaluation, performance analysis, and process improvement.
Education:
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Associate’s degree in Nursing (RN) required; BSN preferred.
Benefits
CVS Health offers competitive compensation and benefits, including:
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Affordable medical, dental, and vision plans.
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401(k) with company match & employee stock purchase plan.
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Paid time off, flexible schedules, and family leave options.
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Tuition assistance & professional development.
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Wellness programs, confidential counseling, and financial coaching.
About CVS Health
At CVS Health, we are transforming healthcare by connecting over 300,000 colleagues across the U.S. with patients and members in meaningful, compassionate ways. Our mission is to help people on their path to better health, and our culture is built on heart, innovation, and inclusion.