Senior Care Coordinator

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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
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