Care Management Associate - Weekend Shift

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.

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.

• 6-8 Week Training will be Monday
  - Friday (8am-5pm) Saturday and Sunday 10-hour shifts with a start time of 8:30am in your time zone.
• All shifts will require Saturdays and Sundays, then the other 2 days can be chosen after the hire date.

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 Med Compass 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.)

• 2-4 years Customer service experience.
• Demonstrates ability to meet daily metrics a with speed, accuracy and a positive attitude and strong written and oral communication skills.
• Strong attention to detail and organizational skills.
• Ability to work independently while collaborating effectively with clinical teams.
• Excellent communication skills for interacting with providers and internal stakeholders.
• Proficiency in navigating healthcare systems and tools (Med Compass experience preferred).
• Commitment to delivering high‑quality service and supporting patient care outcomes.

• 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.

High School Diploma or G.E.D.

40

Full time

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…