# Care Management Associate (CMA)

**Company**: CVS Health
**Location**: Work from home, MO
**Work arrangement**: remote
**Job type**: full-time
**Salary**: $18.50 - $38.82
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/MO---Work-from-home/Care-Management-Associate_R1096102-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/job/care-management-associate-cma-bce5b072-6e8/

## Description

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

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.

**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.

**Benefits:**

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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## Skills

### Required
- health insurance
- healthcare operations
- provider services
- medical office operations
- Utilization Management/Care Management support
- prior authorization

### Nice to have
- MedCompass
- utilization or case management platform
- healthcare provider portals
- research tools
- productivity, quality-audit, and turnaround-time performance measures
- medical billing or coding knowledge
- ICD-10
- CPT
- HCPCS
- NCQA
- URAC
- HIPAA

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/MO---Work-from-home/Care-Management-Associate_R1096102-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)