Care Management Associate

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
As a Care Management Associate (CMA), you will support Utilization Management and Care Management operations by completing non-clinical activities that help move member cases through the review process accurately and timely. You will review and triage work, research and validate member, provider and facility information, conduct provider and facility outreach, document case activity, and prepare or route cases to clinical staff for review.

This is a fast-paced, production and quality-driven role requiring strong attention to detail, effective time management, and the ability to work across multiple systems, applications, and work queues throughout the day. You will be expected to follow established workflows and business rules, adapt to changing processes and technology, and consistently meet turnaround time (TAT), productivity, quality, and documentation expectations.

The CMA works closely with nurses, providers, facilities, and internal partners to reduce administrative burden, maintain accurate case information, support timely clinical review, and help ensure members receive the right care in the right setting at the right time. This reflects the core responsibilities outlined in the current concurrent and preservice CMA materials.

Key Responsibilities:

• Review, intake, screen, and triage Utilization Management and Care Management work based on established workflows, guidelines, and business rules.
• Gather, research, and validate member, provider, facility, admission, authorization, and other information needed to support case processing and clinical review.
• Prepare cases and route work to nurses, medical directors, and other clinical partners as appropriate.
• Conduct outbound outreach to providers and facilities to obtain, clarify, or validate required information.
• Monitor work for missing information, discharge information, documentation needs, or other conditions requiring follow-up or escalation.
• Identify appropriate triggers for referrals or handoffs to Care Management, Disease Management, Transition of Care, and other clinical programs as applicable.
• Accurately document calls, actions, research, outcomes, and follow-up activities in designated systems.
• Navigate multiple systems, work queues, provider portals, and other technology tools throughout the workday while maintaining data accuracy.
• Perform non-clinical research necessary to establish, maintain, process, and close cases.
• Manage assigned work within established turnaround times and appropriately escalate barriers or aging work.
• Meet established productivity and quality expectations while maintaining accuracy and supporting a positive experience for members, providers, and internal partners.
• Protect PHI/PII and comply with HIPAA, privacy, security, regulatory, accreditation, and company requirements.

Required Qualifications:

• 2+ years of experience in health insurance, healthcare operations, provider services, medical office operations, Utilization Management/Care Management support, prior authorization, or a comparable healthcare environment.

Preferred Qualifications:

• Previous experience supporting Utilization Management, prior authorization/precertification, concurrent review, discharge verification, post-acute care, or Care Management.
• Medicare/Medicare Advantage and/or Commercial health-plan experience.
• Experience with MedCompass or another utilization or case management platform.
• Experience using healthcare provider portals and research tools.
• Previous experience working in a remote healthcare operations environment.
• Experience working with established productivity, quality-audit, and turnaround-time performance measures.
• Medical billing or coding knowledge, including familiarity with ICD-10, CPT, and/or HCPCS.
• Familiarity with NCQA, URAC, HIPAA, and other healthcare regulatory or accreditation requirements.
• Associate degree or higher in healthcare, business, or a related field.

Education:
High school diploma or GED.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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.