Inbound/Outbound Queue Associate

CVS Health

. Support comprehensive coordination of medical services, including intake, screening and referrals to Aetna Medical Services Programs .

Posted 10/28/2026full-timeRemote • New Jersey • United StatesJuniorMid-Level💰 $17 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in coordinating medical services, including intake, screening, and referrals, while ensuring compliance with regulatory and accreditation standards. Proficient in using Aetna systems for member information management and maintaining confidentiality of member data.

Highest-signal resume keywords

Medical Services CoordinationIntake and ScreeningAetna Systems ProficiencyBehavioral Health ExperienceBenefits Verification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Services CoordinationIntake and ScreeningBenefits VerificationEligibility ResearchReferral ManagementDocumentation AccuracyMultitaskingClinical Information GatheringRegulatory ComplianceConfidentiality Protection

Soft Skills

CommunicationTeam CollaborationProblem-Solving

Tools & Technologies

ETUMSQNXTProFAXProPATMilliman CriteriaMicrosoft Excel

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

HealthcareBehavioral HealthMedical ManagementRisk ManagementAccreditation StandardsURACNCQA

About the role

Key responsibilities & impact

Support comprehensive coordination of medical services, including intake, screening and referrals to Aetna Medical Services Programs
Support the Behavioral Health team and NJ Behavioral Health team
Perform intake of member or provider calls regarding services via telephone, fax and EDI
Use eTUMS and other Aetna systems to build, research and enter member information
Screen requests for appropriate referral to medical services staff
Approve services not requiring medical review in accordance with benefit plans
Perform eligibility, coordination of benefits and benefits verification research
Maintain accurate documentation meeting risk management, regulatory and accreditation requirements
Communicate with claim administrators, plan sponsors, third-party payers, members, families and healthcare team members
Protect member information confidentiality and follow company policies
Communicate with Aetna Case Managers, Nurses and Medical Directors when processing member transactions
Support precertification processes in compliance with applicable laws, regulations, URAQ and/or NCQA standards
Place outbound provider calls under Medical Management Nurse direction to obtain clinical information for medical authorizations
Use Aetna systems including QNXT, ProFAX, ProPAT and Milliman Criteria

Requirements

What you’ll need

2-4 years of experience as a medical assistant, office assistant or other clinical experience
Working knowledge of Microsoft applications, including Excel
High School diploma or equivalent GED
Experience with Behavioral Health preferred
Healthcare experience preferred
Ability to multitask preferred
Ability to work Monday-Friday, 8:00AM-5:00PM EST

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