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Senior Care Coordinator
Job Description:
- Manage complex utilization management cases, escalations, and payer-specific workflows
- Serve as a subject matter expert and provide peer mentoring, training, and onboarding support
- Conduct quality reviews, audit support, and workflow monitoring activities
- Support supervisors with reporting, operational projects, process improvements, and documentation updates
- Coordinate provider communication, physician reviewer workflows, and escalation resolution
- Assist with special projects, process improvement initiatives, reporting, and departmental operations
- Mentor colleagues and support consistency across utilization management workflows
Requirements:
- High School Diploma or Equivalent Required
- 2–3 Years of Prior Relevant Work Experience Required
- Prior experience in utilization management, care coordination, prior authorization, managed care, or related healthcare operations
- Experience managing payer-specific workflows, coordinating physician reviews, resolving authorization or case escalations, and working with health plan or vendor partners
- Advanced knowledge of utilization management principles and processes, including prior authorization, medical necessity review, level of care determination, and care coordination
- Thorough understanding of payer requirements, regulatory guidelines, accreditation standards, and healthcare compliance requirements
- Ability to independently manage complex utilization management cases, payer-specific workflows, and escalated issues
- Experience coordinating physician reviewer workflows and facilitating timely resolution of escalated cases
- Strong analytical and problem-solving skills
- Experience conducting quality reviews, audits, and workflow monitoring
- Ability to provide peer mentoring, training, onboarding, and operational guidance
- Strong written and verbal communication skills
- Experience reviewing operational reports and performance metrics
- Relevant healthcare, quality, case management, or utilization management certification preferred
- Associates or Bachelor’s Degree Preferred
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting the physical, emotional, and financial well-being of colleagues and their families, based on eligibility
