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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

This will be s** **ubjective to rotating schedule, projected schedule is Mon- Fri 8-5pm.

Supports comprehensive coordination of medical services including intake, screening, and referrals. Promotes and supports quality effectiveness of Healthcare Services. Serves as a training resource, mentor, and subject matter expert.

Required Qualifications

Performs intake of calls from members or providers regarding services via telephone, fax, or EDI. Contacts providers with authorization, denial, and appeals process information; handles difficult customer interactions. Utilizes appropriate system to build, research, and enter member information. Screens requests for appropriate referral to medical services staff. Approves services that do not require a medical review in accordance with the benefit plan. Performs non-medical research including eligibility verification, coordination of benefits, and benefits verification. Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g. claim administrators, Plan Sponsors, and third party payers, as well as member, family, and health care team members. Protects the confidentiality of member information and adheres to company policies regarding confidentiality. Gathers information needed for coordinators/case managers to determine continued authorization. Enters referrals for non-complex services including DME, physical therapy, inpatient and outpatient care, and special circumstance requests as defined by Utilization Management. Provides education and acts as a resource to primary care practices and specialty care providers. Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and NCQA standards, where applicable, while adhering to company policy and procedures. Under the supervision of clinical staff, places outbound calls to providers to obtain clinical information for approval of medical authorizations. Assesses training needs within the team; serves as training resource, mentor, and coach to others. Acts independently and manages own activities with minimal supervision and direction; assists other team members; takes ownership for problem resolution. Demonstrates, advocates, and reinforces a positive team environment. Assists with the identification and reporting of potential quality management issues; responsible for assuring these issues are reported to the Quality Management Department. Performs other related duties as required.

Preferred Qualifications

Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).

Minimum of 3 years experience as an Inbound/Outbound Queue Associate.

Demonstrates initiative and leadership in achieving results.

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 to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.

Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Education

High School Diploma or G.E.D.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $31.72

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: 08/06/2025

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

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.