Senior Care Coordinator

Job not on LinkedIn

🔥 1 hour ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Manage complex utilization management cases, escalations, and payer-specific workflows • Serve as a subject matter expert and provide peer mentoring, training, and onboarding support • Conduct quality reviews, audit support, and workflow monitoring activities • Support supervisors with reporting, operational projects, process improvements, and documentation updates • Coordinate provider communication, physician reviewer workflows, and escalation resolution • Assist with special projects, process improvement initiatives, reporting, and departmental operations • Mentor colleagues and support consistency across utilization management workflows

🎯 Requirements

• High School Diploma or Equivalent Required • 2–3 Years of Prior Relevant Work Experience Required • Prior experience in utilization management, care coordination, prior authorization, managed care, or related healthcare operations • Experience managing payer-specific workflows, coordinating physician reviews, resolving authorization or case escalations, and working with health plan or vendor partners • Advanced knowledge of utilization management principles and processes, including prior authorization, medical necessity review, level of care determination, and care coordination • Thorough understanding of payer requirements, regulatory guidelines, accreditation standards, and healthcare compliance requirements • Ability to independently manage complex utilization management cases, payer-specific workflows, and escalated issues • Experience coordinating physician reviewer workflows and facilitating timely resolution of escalated cases • Strong analytical and problem-solving skills • Experience conducting quality reviews, audits, and workflow monitoring • Ability to provide peer mentoring, training, onboarding, and operational guidance • Strong written and verbal communication skills • Experience reviewing operational reports and performance metrics • Relevant healthcare, quality, case management, or utilization management certification preferred • Associates or Bachelor’s Degree Preferred

🏖️ Benefits

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