Care Management Associate

Job not on LinkedIn

🔥 1 minute ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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• Just posted.
• Jobs at this company usually fill in 21 days.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review, intake, screen, and triage Utilization Management and Care Management work according to workflows, guidelines, and business rules • Gather, research, and validate member, provider, facility, admission, authorization, and other case information • Prepare cases and route work to nurses, medical directors, and other clinical partners • Conduct outbound outreach to providers and facilities to obtain, clarify, or validate information • Monitor work for missing information, discharge information, documentation needs, or conditions requiring follow-up or escalation • Identify triggers for referrals or handoffs to Care Management, Disease Management, Transition of Care, and other clinical programs • Document calls, actions, research, outcomes, and follow-up activities in designated systems • Navigate multiple systems, work queues, provider portals, and technology tools while maintaining data accuracy • Perform non-clinical research to establish, maintain, process, and close cases • Manage assigned work within turnaround times and escalate barriers or aging work • Meet productivity and quality expectations while supporting positive experiences for members, providers, and internal partners • Protect PHI/PII and comply with HIPAA, privacy, security, regulatory, accreditation, and company requirements

🎯 Requirements

• 2+ years of experience in health insurance, healthcare operations, provider services, medical office operations, Utilization Management/Care Management support, prior authorization, or a comparable healthcare environment • High school diploma or GED • Protect PHI/PII and comply with HIPAA, privacy, security, regulatory, accreditation, and company requirements • Ability to work across multiple systems, applications, work queues, provider portals, and technology tools • Ability to meet turnaround time, productivity, quality, and documentation expectations • Strong attention to detail and effective time management • Preferred: Previous experience supporting Utilization Management, prior authorization/precertification, concurrent review, discharge verification, post-acute care, or Care Management • Preferred: Medicare/Medicare Advantage and/or Commercial health-plan experience • Preferred: Experience with MedCompass or another utilization or case management platform • Preferred: Experience using healthcare provider portals and research tools • Preferred: Previous experience working in a remote healthcare operations environment • Preferred: Experience with productivity, quality-audit, and turnaround-time performance measures • Preferred: Medical billing or coding knowledge, including ICD-10, CPT, and/or HCPCS • Preferred: Familiarity with NCQA, URAC, HIPAA, and other healthcare regulatory or accreditation requirements • Preferred: Associate degree or higher in healthcare, business, or a related field

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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