Senior Care Coordinator

CVS Health

. Manage complex utilization management cases, escalations, and payer-specific workflows .

Posted 10/12/2026full-timeRemote • Illinois • United StatesJuniorMid-Level💰 $19 - $39 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in utilization management principles, including prior authorization and care coordination, while effectively managing complex cases and payer-specific workflows. Strong analytical skills and the ability to mentor and train colleagues enhance operational efficiency and compliance.

Highest-signal resume keywords

Utilization ManagementCare CoordinationPayer-Specific WorkflowsQuality ReviewsHealthcare Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization Management PrinciplesPrior AuthorizationMedical Necessity ReviewLevel of Care DeterminationWorkflow MonitoringOperational ReportingPerformance Metrics AnalysisCase Management

Soft Skills

Analytical SkillsProblem-Solving SkillsWritten CommunicationVerbal CommunicationMentoring

Certifications & Qualifications

Healthcare CertificationQuality Management CertificationUtilization Management Certification

Industry Keywords

Managed CareHealthcare OperationsRegulatory GuidelinesAccreditation StandardsEscalation Resolution

About the role

Key responsibilities & impact

Manage complex utilization management cases, escalations, and payer-specific workflows
Serve as a subject matter expert and provide peer mentoring, training, and onboarding support
Conduct quality reviews, audit support, and workflow monitoring activities
Support supervisors with reporting, operational projects, process improvements, and documentation updates
Coordinate provider communication, physician reviewer workflows, and escalation resolution
Assist with special projects, process improvement initiatives, reporting, and departmental operations
Mentor colleagues and support consistency across utilization management workflows

Requirements

What you’ll need

High School Diploma or Equivalent Required
2–3 Years of Prior Relevant Work Experience Required
Prior experience in utilization management, care coordination, prior authorization, managed care, or related healthcare operations
Experience managing payer-specific workflows, coordinating physician reviews, resolving authorization or case escalations, and working with health plan or vendor partners
Advanced knowledge of utilization management principles and processes, including prior authorization, medical necessity review, level of care determination, and care coordination
Thorough understanding of payer requirements, regulatory guidelines, accreditation standards, and healthcare compliance requirements
Ability to independently manage complex utilization management cases, payer-specific workflows, and escalated issues
Experience coordinating physician reviewer workflows and facilitating timely resolution of escalated cases
Strong analytical and problem-solving skills
Experience conducting quality reviews, audits, and workflow monitoring
Ability to provide peer mentoring, training, onboarding, and operational guidance
Strong written and verbal communication skills
Experience reviewing operational reports and performance metrics
Relevant healthcare, quality, case management, or utilization management certification preferred
Associates or Bachelor’s Degree Preferred

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 the physical, emotional, and financial well-being of colleagues and their families, based on eligibility