Care Management Associate

Care Management AssociateWe're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.Position Summary: Training Schedule anytime between: 8:00 am - 7:00 pm EST (this will change once they are out of training).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 healthcare services. Promotes/supports quality effectiveness of Healthcare Services. Responsible for initial review and triage of Care Team 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, Mixed Services, and other Specialty Programs Utilizes Med Compass and other 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 director in the most 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). Performs non-medical research pertinent to the establishment, maintenance and closure of open cases. Provides support services to team members.Required Qualifications• 2-4 years of experience healthcare field, medical/health setting, medical billing, and coding• Experience in call center or customer service environment• Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically• Demonstrates ability to meet daily metrics with speed, accuracy, a positive attitude, and strong written and oral communication skills.• This role requires the ability to work efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems• Technically proficient, with the ability to navigate computer systems and digital tools efficiently• Ability to work independently while collaborating effectively with clinical teams.• Excellent communication skills for interacting with providers and internal stakeholders.• Commitment to delivering high-quality service and supporting patient care outcomes.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.• 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 laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. Customer service experience, Knowledge of Medical TerminologyEducation• High School Diploma or G.E.D.Work from Home Requirements:• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.Technical and Logistical Requirements:• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is: $18.50 - $38.82. 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.We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.We anticipate the application window for this opening will close on: 11/11/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.