Inbound/Outbound Queue Associate

4004 Aetna Medicaid Administrators; New Jersey; Híbrido; USD 23.000 - 43.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Medical Services Coordinator to support intake, screening, and referrals within Aetna Medical Services Programs, with a focus on Behavioral Health support. The role involves handling calls from members and providers, verifying benefits, and ensuring documentation meets regulatory standards.

The position emphasizes confidentiality, accurate data handling, and collaboration with Case Managers and external partners.

Formación

• 2-4 years experience as a medical assistant, office assistant or other clinical experience.

Responsabilidades

• Promotes/supports quality effectiveness of Healthcare Services.
• Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
• Utilizes eTUMS and other Aetna system to build, research and enter member information.
• Screens requests for appropriate referral to medical services staff.
• Approve services that do not require a medical review in accordance with the benefit plan.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Communicate with Aetna Case Managers, when processing transactions for members active in this Program.
• Supports the administration of the precertification process in compliance with various laws and regulations.
• Places outbound calls to providers under the direction of Medical - Management Nurses to obtain clinical information for approval of medical authorizations.
• Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.
• Communicates with Aetna Nurses and Medical Directors, when processing transactions for members active in this Program.

Conocimientos

Medical experience

Office coordination

Communication

Educación

High School diploma or GED

Herramientas

Microsoft Excel

Descripción del empleo

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.

Shift: Monday-Friday, 8:00AM-5:00PM EST

Position Summary

Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs. Additionally, this role will be supporting the Behavioral Health team.

Responsibilities

• Promotes/supports quality effectiveness of Healthcare Services.
• Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
• Utilizes eTUMS and other Aetna system to build, research and enter member information.
• Screens requests for appropriate referral to medical services staff.
• Approve services that do not require a medical review in accordance with the benefit plan.
• Performs non-medical research including eligibility verification, COB, and benefits verification.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan - Sponsors, and third party payers as well as member, family, and health care team members respectively).
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality
• Communicate with Aetna Case Managers, when processing transactions for members active in this Program
• Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• Places outbound calls to providers under the direction of Medical - Management Nurses to obtain clinical information for approval of medical authorizations.
• Uses Aetna Systems such as QNXT, ProFAX, ProPAT, and Milliman Criteria.
• 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 as well as a PC monitor.
• Working environment includes typical office conditions.
• Will support the NJ Behavioral Health team.

Required Qualifications

• 2-4 years experience as a medical assistant, office assistant or other clinical experience.
• Microsoft Applications working with excel.

Preferred Qualifications

• Experience with Behavioral Health.
• Healthcare experience.
• Able to Multitask.

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: $17.00 - $31.30 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 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: 11/04/2026

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

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 programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, 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.