This a Full Remote job, the offer is available from: United States, Texas (USA)
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.
Primary Job Duties & Responsibilities
Evaluates patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan. Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director
Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
Assist in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.
Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.
Required Qualifications:
Relevant work experience
Adept at problem solving and decision making skills
Preferred Qualifications:
Telephonic experience
Member outreach experience
Education
High school diploma
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
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 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 11/05/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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