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This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.
Role Description
Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health.
Promotes/supports quality effectiveness of Healthcare Services.
Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
Utilizes Aetna system to build, research and enter member information.
Screens requests for appropriate referral to medical services staff.
Approve services that do not require a medical review in accordance with the benefit plan.
Performs non-medical research including eligibility verification, COB, 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 respectively).
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Communicate with Aetna Case Managers, when processing transactions for members active in this Program.
Supports the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards, where applicable, while adhering to company policy and procedures.
Places outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations.
Uses Aetna Systems such as MedCompass, QNXT, SSA, ProFAX and ProPAT.
Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program.
Sedentary work involving significant periods of sitting, talking, hearing, and keying.
Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor.
Qualifications
1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience.
Requirements
Call center experience is preferred, 1-2 years.
Prior authorization experience, 1-2 years.
Education
High School diploma or equivalent GED.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is: $17.00 - $31.30. 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.
Benefits
Affordable medical plan options.
401(k) plan (including matching company contributions).
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.
Application Information
We anticipate the application window for this opening will close on: 01/12/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
