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 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:

• Support comprehensive coordination of medical services including Care Team intake and outreach, screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
• Promotes/supports quality effectiveness of Healthcare Services.
• Responsible for initial review and outreach tasks.
• Tracks Medicaid redetermination and researches eligibility issues.
• Tracks and ensures Level of Care compliance standards set by the State.
• Utilizes Dynamo, QNXT and other Aetna systems to build, research and enter member information, as needed.
• Assists Case Managers with coordination of benefits and services.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively)
• Performs non-medical research pertinent to the establishment, maintenance and closure of open cases.
• Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
• Adheres to Compliance with Policies and Regulatory Standards.
• Maintains accurate and complete documentation of required information that meets contract requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Create authorizations, outreach providers, bridge service gaps, assist with claims resolution and monitor authorization & claims reports.

Required Qualifications :

• 1+ years experience as a medical assistant, office assistant or member services representative in a healthcare setting.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Preferred Qualifications:

• Bilingual - Spanish
• 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.
• Experience with long term care, managed care or medical care.
• Effective communication, telephonic and organization skills.
• Familiarity with basic medical terminology and concepts used in care management.
• Strong customer service skills to coordinate service delivery including attention
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Education:

• High School diploma or equivalent

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 03/19/2026

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