Care Management Associate

CVS Health Careers

. Review, intake, screen, and triage Utilization Management and Care Management work according to workflows, guidelines, and business rules .

Posted 11/10/2026full-timeRemote • Missouri • United StatesJuniorMid-Level💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and Care Management processes, ensuring compliance with HIPAA and other regulatory requirements while effectively managing case documentation and provider outreach. Proficient in navigating multiple healthcare systems and maintaining data accuracy to support operational efficiency.

Highest-signal resume keywords

Utilization Management SupportHIPAA ComplianceHealthcare Operations ExperienceAttention To DetailProvider Portal Navigation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementPrior AuthorizationMedical Billing KnowledgeICD-10 CodingCPT CodingHCPCS CodingDocumentation ManagementData AccuracyResearch SkillsProductivity Measurement

Soft Skills

Effective Time ManagementStrong CommunicationDetail OrientationProblem-SolvingCollaboration

Tools & Technologies

MedCompassHealthcare Provider PortalsCase Management PlatformsData Management SystemsResearch Tools

Industry Keywords

PHI ProtectionPII ProtectionNCQAURACMedicare AdvantageCommercial Health-Plan ExperienceHealthcare Regulatory ComplianceAccreditation StandardsRemote Healthcare Operations

About the role

Key responsibilities & impact

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

What you’ll need

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

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 in addition to base pay