At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
Care Management Associate
As a Care Management Associate, you will play a critical role in supporting our clinical partners and ensuring seamless coordination of medical management services. This position focuses on the initial review and triage of Medical Inpatient tasks, helping to maintain accuracy and efficiency in patient care processes.
Key Responsibilities:
A Care Management Associate will conduct initial reviews and triage inpatient medical tasks to ensure timely and accurate case routing. Verify essential admission details, including the principal reason for admission, facility information, and member product, to correctly update and forward cases for clinical review. Monitor cases for appropriate discharge dates and dispositions, maintaining data integrity throughout the process. Additionally, they will be responsible for identifying and escalating outlier cases, such as extended lengths of stay, to clinical staff for further evaluation, and recognize triggers for referral into Aetna’s Case Management programs to support continuity of care. Other responsibilities also include utilizing MedCompass and other Aetna systems to research, build, and maintain accurate member information, promoting effective communication internally and externally to enhance collaboration among healthcare providers and team members. Perform non-medical research to support case establishment, maintenance, and closure, provide administrative and operational support to team members as needed, and make outbound calls to providers daily to gather or verify information. (Note: This is not an inbound call center role.)
Required Qualifications
Schedule is Saturday and Sunday (10 hour shifts) with 2 weekdays (10 hour shifts). Weekend start time must be on or after 8:30 am local time. Weekdays will be set by the colleague with management approval. Training will be 6 weeks from 8-430 EST, after that, schedule will be M-F 830-5 in their own time zone until they show they are proficient in the processes, then they would be moved to the weekend.
Preferred Qualifications
· Researching information and assisting in solving problems
· Knowledge of Medical Terminology
· Adheres to Compliance with PM Policies and Regulatory Standards
· Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
· Protects the confidentiality of member information and adheres to company policies regarding confidentiality
· May assist in the research and resolution of claims payment issues - Supports the administration of the hospital care, case management and quality management processes in compliance with various law and regulation, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.
· Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
· 2-4 years of experience healthcare field, medical/health setting, medical billing and coding.
Education
High School Diploma or G.E.D.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $35.29This 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: 12/27/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.