This is a medical services coordination job: you’re basically the front door for Aetna Medical Services Programs. You take inbound requests (members/providers), do eligibility and benefits verification, document everything cleanly, route cases to the right clinical staff, and make outbound calls to providers to collect clinical info for authorizations.
About CVS Health
CVS Health (Aetna) supports members with medical management services and authorization workflows, aiming for quality, compliant, well-documented care coordination.
Schedule
- Sunday, Monday, Tuesday, Thursday, Friday
- 1:00 PM – 10:00 PM EST
- Full-time, 40 hours/week
- Remote, but you must live in Maryland
What You’ll Do
- Take intake via phone, fax, EDI from members/providers about services
- Enter/research member info using eTUMS and other Aetna systems
- Screen requests and route to medical services staff when clinical review is needed
- Approve services that don’t require medical review (per benefit plan)
- Do non-medical research: eligibility verification, COB, benefits verification
- Maintain accurate documentation aligned with regulatory, risk, and accreditation standards
- Coordinate communication with claim admins, plan sponsors, payers, members/families, and care teams
- Communicate with Aetna Case Managers, Nurses, and Medical Directors as needed
- Support precertification compliance (URAQ/NCQA standards where applicable)
- Make outbound calls to providers to obtain clinical info for medical authorization decisions
- Use systems like QNXT, ProFAX, ProPAT, and Milliman criteria
- Role is sedentary with heavy computer/phone work
What You Need
- 2–4 years experience as a medical assistant, office assistant, or other clinical experience
- Must reside in Maryland
- High school diploma or GED
Benefits
- Pay range: $17.00 – $31.30/hour (final offer varies)
- CVS benefits package (medical plans, 401(k) match, employee stock purchase, PTO, wellness programs, etc.)
Urgency
Application window expected to close: 02/04/2026.
Quick gut-check (because this matters): this is a systems-heavy, documentation-heavy job. If you’re calm on the phone, can keep your notes tight, and don’t crumble under “the queue never ends” energy, you’ll be fine. If constant calls + strict workflows make you want to launch your headset into the sun, skip it.
Happy Hunting,
~Two Chicks…