Care Management Associate - Work From Home

CVS Health; Texas; À distance; USD 25 000 - 49 000; Plein temps

Avantages offerts par ce poste

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Résumé du poste

CVS Health is hiring for a role supporting the National Medical Excellence Program with inbound calls from providers and members. You will use multiple Aetna systems to build and verify member data and support non-medical research like eligibility and benefits verification.

Responsibilities include processing referrals, coordinating with clinical teams, and initiating transplant authorizations while ensuring confidentiality and regulatory compliance.

Qualifications

• 2+ years’ experience as a medical assistant or equivalent clinical role.
• Proficient with Microsoft Excel and basic office software.
• Ability to communicate with diverse populations effectively.
• Strong teamwork and collaboration in a patient-centered environment.
• Flexibility to work independently as needed.

Responsabilités

• Handle intake of calls from providers or members.
• Use Aetna systems (MedCompass, HRP, ASD, CEC, ATV) to build and enter member data.
• Conduct non‑medical research including eligibility and benefits verification.
• Record required information accurately and meet regulatory standards.
• Process referrals and outreach calls via telephone, fax, or EDI.
• Collaborate with clinical, claims, and contacting staff.
• Communicate with transplant financial coordinator and transplant center staff.
• Initiate authorizations for kidney transplants per unit process.
• Communicate transplant services details to members or providers.
• Create shell cases for transplant, cellular therapy, and gene therapy requests.

Connaissances

Medical software communication

Call center experience

Team collaboration

Independent work

Diversity communication

Formation

High School Diploma or GED

Associate Degree Preferred

Outils

Microsoft Excel

Description du poste

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 prioritize 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

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

Additional responsibilities to include but not limited to the following:

• Performes intake of calls from providers or members
• Utilizes Aetna Systems such as MedCompass, HRP, ASD, CEC, and ATV and other Aetna systems to build, research and enter member information in applicable system.
• Performes non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information and meets risk management, regulatory and accreditation requirements.
• Performes intake of calls from members or providers regarding services via telephone, fax, EDI.
• These duties may include but are not limited to processing referrals, making outreach calls, entering data.
• Collaborates with the clinical team, medical directors, claims and contacting staff.
• Communicates with transplant financial coordinator at the transplant center.
• Initiates authorizations regarding kidney transplants in accordance with unit processes.
• Communicates with the member or provider regarding transplant services.
• Build shell cases for transplant, cellular therapy, and gene therapy services request and task to nurse review.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., Providers, family, and health care team members respectively)
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Supports the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program.
• Sedentary work involving significant periods of sitting, talking, hearing, and keying.
• Work requires visual acuity to perform close inspection of written and computer-generated documents
• Other duties as assigned.

Required Qualifications

• 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

Preferred Qualifications

• 1+ years prior Insurance experience, preferably in a Call Center.
• Telephonic Customer Service experience
• 1+ years of prior authorization experience

Education

• High School Diploma or equivalent GED Required
• Associate Degree Preferred

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 program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

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 programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments .

We anticipate the application window for this opening will close on: 11/23/2026

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