Care Management Associate

CVS Health

. Support comprehensive coordination of medical services through intake and outgoing calls .

Posted 10/6/2026full-timeRemote • Texas • United StatesJuniorMid-Level💰 $19 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in coordinating medical services, including eligibility review, pre-certification processes, and effective communication with healthcare teams. Proficient in utilizing internal tools for case management while maintaining compliance with regulatory and accreditation standards.

Highest-signal resume keywords

Medical Terminology FamiliarityCall Center ExperienceCustomer Service SkillsDocumentation AccuracyComputer Literacy

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementEligibility ReviewPre-Certification ProcessesIntervention Business RulesReferral Coordination

Soft Skills

Effective CommunicationOrganizational SkillsProactive Problem SolvingAttention to Detail

Tools & Technologies

Microsoft ExcelMicrosoft Word

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Healthcare CoordinationRisk ManagementRegulatory ComplianceAccreditation Standards

About the role

Key responsibilities & impact

Support comprehensive coordination of medical services through intake and outgoing calls
Work closely with case management and utilization management teams
Review eligibility and benefits
Open pre-certification cases and approve or send cases to nursing staff for review
Evaluate patients using targeted intervention business rules and processes
Identify needed medical services, make appropriate referrals, and coordinate services according to the benefit plan
Communicate health care service delivery based on nurse or medical director outcomes/reviews
Perform non-medical research for establishment, maintenance, and closure of open cases
Answer provider and member telephone calls, take accurate messages, and support electronic transmission review and referrals
Use internal tools to determine required review steps based on clinical requirements and plan guidelines
Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
Communicate internally and externally with providers and health care team members
Obtain discharge dates and make appropriate referrals to clinical teams for follow-up
Work independently when needed while following department guidelines, policies, and procedures
Meet quality and quantity performance standards in a rapidly changing environment

Requirements

What you’ll need

2 years’ experience as a medical assistant, office assistant or related experience
Minimum of 6 months of call center experience required
Effective communication, telephonic and organization skills
Familiarity with basic medical terminology and concepts used in care management
Strong customer service skills, including attention to customers, sensitivity to issues, proactive identification and resolution of issues
Computer literacy to navigate internal/external computer systems, including Excel and Microsoft Word
High School Diploma or equivalent GED
Ability to work shifts based on a Central Time schedule; ideally 9:30am–6pm Central time

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility