[Hiring] Care Planner @CVS Health

Role Description

Join the Behavioral Health Division of Aetna/CVS Health as a Care Planner, where you’ll play a meaningful part in helping members access the behavioral health support and documentation they need. In this role, you’ll collaborate with Medical Directors, clinicians, and customer service teams to support higher‑level case reviews and ensure timely, accurate processing. You’ll also help maintain our state regulatory compliance and support our NCQA accreditation—key functions that keep our care programs running smoothly and effectively.

What You’ll Do

• Support clinical teams to enhance the quality and coordination of member care
• Prepare administrative and medical‑necessity determination letters with accuracy and clarity
• Communicate results of medical reviews to providers and utilization teams, including next steps
• Schedule and coordinate appointments between providers and Aetna Medical Directors or Consultants
• Gather appropriate documentation for clinical appointments and track deadlines to ensure timely completion
• Ensure compliance with state requirements and Aetna policies, using strong attention to detail across varying protocols

Qualifications

• 2+ years of experience in one of the following:
  • Health insurance
  • Administrative/secretarial work
  • Customer service within a healthcare or mental health environment
• Ability to type 60–70 words per minute
• Proficiency with Microsoft Office Suite (Outlook, Word, Excel)

Requirements

• Strong organizational and time‑management abilities
• Excellent written and verbal communication skills
• Understanding of commercial insurance products
• Understanding of mental health and substance abuse related levels of care
• Strong attention to detail and ability to problem solve to meet specific requirements
• Associate degree or equivalent experience in the healthcare industry

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum internet speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility

Pay Range

The typical pay range for this role is: $21.10 - $36.78. 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.