Care Management Associate

CVS Health Corporation; Northern (KY); Hybrid; USD 26,000 - 48,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programmes

Job summary

CVS Health is seeking a Care Management Associate to support medical services coordination, including intake and outgoing calls, reviews of eligibility and benefits, and pre-certification processing. The role works with the case management and utilization management teams to ensure timely, compliant delivery of care.

Responsibilities include using business rules to identify needed services, making referrals, communicating care plans, and documenting activities to meet regulatory standards.

Qualifications

• 2 years’ experience as a medical assistant, office assistant or related experience.
• Minimum of 6 months of call centre experience required.

Responsibilities

• Evaluates patients and coordinates required services per benefit plan.
• Reviews eligibility and benefits and opens pre-certification cases.
• Communicates health care service delivery based on clinical requirements.
• Maintains accurate documentation meeting risk, regulatory, and accreditation standards.
• Answers calls from providers and members, supports referrals and message-taking.

Skills

Effective communication

Telephonic skills

Organization skills

Education

High School Diploma or GED

Tools

Excel

Microsoft Word

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritise safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services. We work closely with both case management team and utilisation management team. The Care Management Associate will review eligibility and benefits and open pre‑certification cases and either approve or send to nursing staff for review.

• Evaluates patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan.
• Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director.
• Performs non‑medical research pertinent to the establishment, maintenance, and closure of open cases.
• Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
• Assist in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
• Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.
• Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.

Required Qualifications

• 2 years’ experience as a medical assistant, office assistant or related experience.
• Minimum of 6 months of call centre experience required.

Preferred Qualifications

• Effective communication, telephonic and organisation skills.
• Familiarity with basic medical terminology and concepts used in care management.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members.
• Computer literacy to navigate through Internal/external computer systems, including Excel and Microsoft Word.

Education

High School Diploma or equivalent GED

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $18.50 - $35.29. This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive programme in addition to the base pay range listed above.

Benefits

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programmes, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our Work Experience is the combination of everything that’s unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programmes, but most importantly, it’s our people. Our employees are self‑disciplined, hardworking, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

We anticipate the application window for this opening will close on: 08/31/2026