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.
**Position Summary**
**100% remote position from anywhere in the U.S.**
**Work hours: 11:30am-8:00pm EST, Monday-Friday.**
**Weekend/holiday coverage will occasionally be required.**
**100% attendance is required during the first 3 weeks of training / 8:30am-5pm EST, Monday-Friday.**
American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.
+ Work in clinical telephone queue for 3 to 4 hours a day working with providers to secure additional information for prior authorization review.
+ This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
+ Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
+ Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render determination/recommendation along the continuum of care.
+ Communicates with providers and other parties to facilitate care/treatment.
+ Identifies members for referral opportunities to integrate with other products, services and/or programs.
+ Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
+ Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
+ _WFH and hybrid Colleagues must manage dependent care and other personal responsibilities in a way that allows them to successfully meet job responsibilities while working from their virtual work location. Dependent care performed during work hours is generally not permissible, as it creates the potential for unnecessary interruptions and distractions from work._
**Required Qualifications**
+ 1 year of varied UM (utilization management) experience within an **outpatient** setting, concurrent review or prior authorization.
+ 5 years of a variety clinical experience required including acute care, home health, or long-term care.
+ 5 years demonstrated ability to make thorough, independent decisions using clinical judgement.
+ A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all noncompact states.
+ Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service.
**Preferred Qualifications**
+ 1+ years Managed Care (MCO) preferred.
+ 1+ years demonstrated experience working in a high-volume clinical call center environment.
+ 1 year of varied UM (utilization management) experience within an inpatient, concurrent review or prior authorization.
+ Remote work experience.
**Education**
+ Associate 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:
$26.01 - $74.78
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.
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 all 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
We anticipate the application window for this opening will close on: 09/04/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.