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Care Management Associate
CVS Health Careers. Support the coordination of healthcare services through intake, screening, referral management, and care plan implementation.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare coordination, case management, and utilization management while ensuring compliance with HIPAA and regulatory standards. Proficient in managing member engagement and facilitating communication among healthcare providers and internal stakeholders.
Highest-signal resume keywords
Healthcare CoordinationCase ManagementUtilization ManagementMicrosoft Office Suite ProficiencyMedical Terminology Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care CoordinationCase DocumentationReferral ManagementAssessment Tools ApplicationElectronic Medical Records (EMRs)Healthcare DatabasesCare Management PlatformsClaims Payment ResolutionBenefit Plan CoordinationTriage of Member Cases
Soft Skills
Strong Verbal CommunicationStrong Written CommunicationExcellent Organizational SkillsProblem-Solving SkillsCustomer Service Skills
Tools & Technologies
Microsoft OutlookMicrosoft TeamsMicrosoft WordMicrosoft Excel
Industry Keywords
HIPAA ComplianceNCQAURACCMSAHealthcare Delivery SystemsManaged CareHealth InsuranceHealthcare OperationsPublic HealthSocial Services
About the role
Key responsibilities & impact- Support the coordination of healthcare services through intake, screening, referral management, and care plan implementation.
- Conduct initial review and triage of Care Team tasks and member cases.
- Identify the principal reason for admission, facility type, and member product to accurately apply assessment and intervention tools.
- Screen members using established clinical and business rules to identify appropriate healthcare services and referrals.
- Coordinate services in accordance with benefit plans and organizational guidelines.
- Monitor cases to ensure accurate discharge dates and dispositions are documented.
- Identify and escalate complex or outlier cases, including extended length-of-stay situations, to clinical staff.
- Recognize opportunities for referral to Case Management, Disease Management, Specialty Programs, and other care management services.
- Assist with the development, implementation, and coordination of care plans under the direction of nurses and medical directors.
- Help members access appropriate providers and services while supporting cost-effective care delivery.
- Promote member engagement and continuity of care.
- Serve as a primary point of contact for members, providers, and internal stakeholders.
- Facilitate communication between healthcare providers, care teams, and business partners.
- Provide administrative and operational support, respond to inquiries, research information, and resolve routine issues.
- Maintain timely, accurate, and complete case documentation in accordance with policies, regulations, accreditation standards, and risk management guidelines.
- Protect member confidentiality and ensure HIPAA and privacy compliance.
- Support hospital care management, utilization management, quality management, and case management processes.
- Assist with research and resolution of claims payment inquiries.
- Utilize internal healthcare management systems to research, update, and maintain member information.
- Perform non-clinical research and maintain accurate records across multiple systems and platforms.
Requirements
What you’ll need- High School Diploma or GED required.
- 1+ year of experience in healthcare, call center, customer service, care coordination, case management support, utilization management, health insurance, hospital operations, or a related field.
- Strong verbal and written communication skills.
- Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
- Proficiency with Microsoft Office Suite, including Outlook, Teams, Word, and Excel.
- Ability to handle confidential and sensitive information professionally.
- Strong problem-solving and customer service skills.
- Associate’s or Bachelor's degree in Healthcare Administration, Public Health, Nursing, Social Services, or a related field preferred.
- Experience in managed care, healthcare operations, utilization management, case management, or health insurance preferred.
- Knowledge of medical terminology, healthcare delivery systems, and insurance benefits preferred.
- Experience working with electronic medical records (EMRs), healthcare databases, or care management platforms preferred.
- Familiarity with NCQA, URAC, CMSA, HIPAA, and regulatory healthcare standards preferred.
- Experience supporting members, providers, or clinical teams in a healthcare environment preferred.
Benefits
Comp & perks- 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 eligibility