Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryFully remote. Work anywhere in the U.S.Schedule: Monday – Friday 10:30 AM - 7:00 PM Eastern Standard Time (some holiday and weekend coverage is required with this position)Care Planner position would work within the Commercial and IFP membership of the Behavioral Health Division of Aetna/CVS. Would work closely with Medical Directors, Clinicians and Customer Service to process higher level reviews.The Care Planner would be an integral part of managing our state policies, our NCQA accreditation, and helping our members get the help and documentation that they need.Additional responsibilities to include but limited to the following:
Provide service to clinical teams in support of optimal care.
Generates administrative and medical necessity denial letters, checking for accuracy and appropriateness.
Makes calls to providers and utilization reviewers to provide results of medical necessity determinations and provides specifics for next steps.
Schedules and coordinates appointments between providers or attending physicians and Aetna Medical Directors or Consultants.
Collects and provides necessary material for appointments. Calculates deadlines for appointments and monitor cases for timely return.
Complies with state mandated and Aetna regulations by monitoring documentation, checks for nuances before action taken and follows varying protocols by case or situation.
Required Qualifications
2 plus years experience in health insurance field or
2 plus years Administrative/ Secretarial experience or
2 plus years Customer service experience within health care or a mental health capacity
Ability to type 60-70 words per minute
Demonstrated knowledge and experience using Microsoft Office Suite, including: Outlook, Word, and Excel
Preferred Qualifications
Good organizational skills
Able to work independently and hits goals
Excellent communication
EducationAssociates degree or equivalent experienceAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$21.10 - $49.08This 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.In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)We anticipate the application window for this opening will close on: 02/24/2025Qualified 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.
