Senior Care Coordinator

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Oversee intricate utilization management cases, escalations, and workflows specific to payers.

• Act as a subject matter authority while providing mentoring, training, and onboarding assistance to peers.

• Perform quality assessments, audit support, and monitor workflow activities.

• Assist supervisors with reporting, operational initiatives, process enhancements, and updates to documentation.

• Facilitate communication with providers, coordinate physician reviewer workflows, and resolve escalations.

• Aid in special projects, process improvement efforts, reporting, and departmental functions.

• Guide colleagues and ensure consistency in utilization management workflows.

⛳️ Requirements

• High School Diploma or Equivalent is mandatory.

• A minimum of 2–3 years of relevant work experience is required.

• Previous experience in utilization management, care coordination, prior authorization, managed care, or equivalent healthcare operations.

• Familiarity with managing payer-specific workflows, coordinating physician reviews, resolving authorization or case escalations, and collaborating with health plan or vendor partners.

• In-depth knowledge of utilization management principles and processes, including prior authorization, medical necessity evaluation, level of care assessment, and care coordination.

• Comprehensive understanding of payer requirements, regulatory guidelines, accreditation standards, and healthcare compliance mandates.

• Capability to independently manage complex utilization management cases, payer-specific workflows, and escalated issues.

• Experience in coordinating physician reviewer workflows and ensuring the prompt resolution of escalated cases.

• Strong analytical and problem-solving abilities.

• Experience in conducting quality reviews, audits, and workflow monitoring.

• Ability to offer peer mentoring, training, onboarding, and operational direction.

• Excellent written and verbal communication skills.

• Familiarity with reviewing operational reports and performance metrics.

• Relevant certifications in healthcare, quality, case management, or utilization management are preferred.

• An Associate’s or Bachelor’s Degree is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness initiatives.

• Additional resources that promote the physical, emotional, and financial well-being of employees and their families, contingent on eligibility.