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**
As a Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare Services.
**Position Responsibilities:**
+ Responsible for initial review and triage of Care Teams tasks.
+ Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
+ Screens patients using targeted intervention business rules and processes to identify needed medical services.
+ Make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
+ Monitors non-targeted cases for entry of appropriate discharge date and disposition.
+ Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
+ Utilizes Med Compass and Aetna systems to build, research and enter member information as needed.
+ Support the development and Implementation of Care Plans.
+ Coordinates and arranges for health care service delivery under the direction of nurse or medical direction in the appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
+ Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
+ Perform non-medical research pertinent to the establishment, maintenance and closure of open cases.
+ Provides support services to team member.
+ May assist in the research and resolution of claims payment issues - Supports the administration of the hospital care, case management and quality management processes in compliance with various law and regulation, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures..
+ **Hours of Operation Training and Work schedule will be between the hours of 8:00 AM-8:00 PM ET, 8-hour shift between this timeframe within your designated time zone. Candidate would be working a later scheduled shift (i.e. 10:30am to 7:00pm).**
+ **Weekend and Holiday hours will be required.**
**Required Qualifications**
+ 2-4 years of experience within the healthcare field, medical/health setting, medical billing and coding.
+ Experience in call center or customer service environment.
+ Ability to work independently, meeting deliverables and deadlines with demonstrating and outgoing, enthusiastic and caring presence telephonically.
+ Demonstrates ability to meet daily metrics a with speed, accuracy and a positive attitude and strong written and oral communication skills.
**Preferred Qualifications**
+ Researching information and assisting in solving problems
+ Adheres to Compliance with PM Policies and Regulatory Standards
+ Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
+ Protects the confidentiality of member information and adheres to company policies regarding confidentiality
+ Demonstrated ability to handle multiple assignments, accurately, and efficiently.
+ Knowledge of Medical Terminology.
**Education**
+ High School Diploma or G.E.D.
**Anticipated Weekly Hours**
40
**Time Type**
Full time
**Pay Range**
The typical pay range for this role is:
$18.50 - $42.35
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: 12/01/2025
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.