Care Management Associate

CVS Health

. Support comprehensive coordination of the National Medical Excellence Program by handling inbound calls from the phone queue .

Posted 10/22/2026full-timeRemote • United StatesJuniorMid-Level💰 $19 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing inbound calls and performing call intake while ensuring compliance with regulatory and accreditation standards. Proficient in utilizing Aetna systems for member information management and conducting non-medical research related to eligibility and benefits verification.

Highest-signal resume keywords

Aetna Systems ProficiencyCall Center ExperiencePrior Authorization ExperienceMedical Documentation AccuracyCustomer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Call IntakeBenefits VerificationData EntryEligibility ResearchReferral ProcessingMicrosoft Office SuiteExcelTelephonic CommunicationMedical Management ServicesConfidentiality Compliance

Soft Skills

Team CollaborationFlexibilityIndependent WorkCommunication with Diverse Populations

Tools & Technologies

MedCompassHRPASDCECATV

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

National Medical Excellence ProgramPrecertification AdministrationNCQA StandardsTransplant AuthorizationCellular TherapyGene Therapy

About the role

Key responsibilities & impact

Support comprehensive coordination of the National Medical Excellence Program by handling inbound calls from the phone queue
Perform call intake from providers and members
Use Aetna systems including MedCompass, HRP, ASD, CEC, and ATV to build, research, and enter member information
Conduct non-medical research, including eligibility, coordination of benefits, and benefits verification
Maintain accurate documentation and meet risk management, regulatory, and accreditation requirements
Process referrals, make outreach calls, and enter data via telephone, fax, and EDI
Collaborate with clinical teams, medical directors, claims, and contacting staff
Communicate with transplant financial coordinators, members, providers, Aetna nurses, and medical directors
Initiate kidney transplant authorizations according to unit processes
Build shell cases for transplant, cellular therapy, and gene therapy requests and task them for nurse review
Promote internal and external communication to enhance medical management services
Protect member confidentiality and follow company confidentiality policies
Support precertification administration in compliance with applicable laws, regulations, NCQA standards, and company procedures
Perform sedentary work involving sitting, talking, hearing, and keying
Perform close inspection of written and computer-generated documents
Perform other duties as assigned

Requirements

What you’ll need

2+ years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
Computer skills, including Microsoft Office Suite, specifically Excel
Ability to communicate with diverse populations
Ability to collaborate with and work in a team environment
Flexibility and ability to work independently
High School Diploma or equivalent GED required
40 hours per week
Preferred: 1+ years prior insurance experience, preferably in a call center
Preferred: Telephonic customer service experience
Preferred: 1+ years of prior authorization experience
Associate Degree 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 in addition to base pay