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Position Summary
100% remote position from anywhere in the U.S.

Work hours: 11:30am-8:00pm EST, Monday-Friday. MUST have the ability to work the occasional on-call rotational coverage on weekends and some rotational on-call holiday coverage (URAC and Client Requirements). Utilization Management is a 24/7 operation.

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 with providers to secure information to complete medical necessity reviews for Oncology and Transplant related services.

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient requiring precertification. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers.

Utilization Management nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.

Position requires proficiency with computer skills which includes navigating multiple systems. Sedentary work involves periods of sitting, talking, listening and computer use. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers.

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: Oncology and Transplant UM, concurrent review or prior authorization
• 3+ years: acute clinical Oncology or Oncology/Transplant experience
• Required to attend the first 3 weeks training with 100% participation during 8:30am-5pm Monday-Friday EST
• 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 non-compact states.

Preferred Qualifications

• 1+ years Managed Care (MCO) preferred
• 1+ years experience working in a high volume clinical call center environment Remote work experience

Education
Associate degree in nursing RN required, BSN preferred

Pay Range

The typical pay range for this role is:

$26.01 - $56.14

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/22/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.