Care Planner - Behavioral Health - Commercial Plans

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.

Monday-Friday, 8:00am-5:30pmEST (Some company holiday and weekend coverage may be required)

Work from your home, anywhere in the United States

Join the Behavioral Health Division of Aetna/CVS Health as a Care Planner, where you'll play a meaningful part in helping members access the behavior health support and documentation they need. In this role, you'll collaborate with Medical Directors, clinicians, and customer service teams to support higher‑level case reviews and ensure timely, accurate processing.

You'll also help maintain our state regulatory compliance and support our NCQA accreditation-key functions that keep our care programs running smoothly and effectively.

• Support clinical teams to enhance the quality and coordination of member care
• Prepare administrative and medical‑necessity determination letters with accuracy and clarity
• Communicate results of medical reviews to providers and utilization teams, including next steps
• Schedule and coordinate appointments between providers and Aetna Medical Directors or Consultants
• Gather appropriate documentation for clinical appointments and track deadlines to ensure timely completion
  
  Ensure compliance with state requirements and Aetna policies, using strong attention to detail across varying protocols

• 2+ years of experience in one of the following:
  • Health insurance
  • Administrative/secretarial work
  • Customer service within a healthcare or mental health environment
• Ability to type 60-70 words per minute
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel)

• Strong organizational and time‑management abilities
• Excellent written and verbal communication skills
• Understanding of commercial insurance products
• Understanding of mental health and substance abuse related levels of care
• Strong attention to detail and ability to problem solve to meet specific requirements

• Associate degree or equivalent experience, i.e experience in the healthcare industry.

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum internet speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

• Device & System Navigation
  :
  Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools
  :
  Ability to communicate on digital…