Care Management Associate

CVS Health • Washington, NV

1d • $19 - $39

About The Position

The Care Management Associate (CMA) supports Utilization Management and Care Management operations by completing non-clinical activities that help move member cases through the review process accurately and on time. The role involves reviewing and triaging work, researching and validating member, provider, and facility information, conducting outreach, documenting case activity, and preparing or routing cases to clinical staff for review.

This is a fast-paced, production- and quality-driven role requiring attention to detail, effective time management, and the ability to work across multiple systems, applications, and work queues. The CMA follows established workflows and business rules, adapts to changing processes and technology, and meets turnaround-time, productivity, quality, and documentation expectations.

The CMA works closely with nurses, providers, facilities, and internal partners to reduce administrative burden, maintain accurate case information, support timely clinical review, and help members receive the right care in the right setting at the right time.

Requirements

• At least 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.

Nice To Haves

• Previous experience supporting Utilization Management, prior authorization/precertification, concurrent review, discharge verification, post-acute care, or Care Management.
• Medicare/Medicare Advantage and/or Commercial health-plan experience.
• Experience with MedCompass or another utilization or case management platform.
• Experience using healthcare provider portals and research tools.
• Previous experience working in a remote healthcare operations environment.
• Experience working with established productivity, quality-audit, and turnaround-time performance measures.
• Medical billing or coding knowledge, including familiarity with ICD-10, CPT, and/or HCPCS.
• Familiarity with NCQA, URAC, HIPAA, and other healthcare regulatory or accreditation requirements.
• Associate degree or higher in healthcare, business, or a related field.

Responsibilities

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

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED