Inbound Outbound Queue Associate - OhioRISE - must reside in Ohio - OH - Work from hom | CVS Health Job

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.

Supports comprehensive coordination of medical services including Care Team intake, screening, and supporting the implementation of care plans to promote effective utilization of healthcare services. The position promotes/ supports quality effectiveness of Healthcare Services.

• Adheres to compliance with policies and procedure/regulatory standards. 
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. 
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.   
• Responsible for initial review and triage of care team tasks and ongoing management of Care Plan Review tasks.
• Supports the development, implementation, and follow-up of care plans.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., providers, and health care team members respectively).
• Enter and maintain member records in electronic health record system, compile reports and complete other program documentation in a timely manner (e.g., progress notes, letters), and other administrative responsibilities as needed.
• Completes documentation in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency. 
• Provides non-medical research including eligibility verification, COB and benefits verification.
• Communicate with Aetna internal teams when processing transitions for members active in this program.

Required Qualifications

• Must reside in Ohio
• Effective communication and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.  
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures). 
• Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency. 
• Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic, and caring presence.   
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records.
• Strong organizational skills, including effective verbal and written communication skills.  

Preferred Qualifications

• 2+ years experience in healthcare field (i.e., experienced in medical office, hospital setting) preferred.  
• Familiarity with basic behavioral medical terminology and concepts used in care management preferred. 

Education

• High School diploma, G.E.D. or equivalent. 

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.