At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
The Consumer Direction Advocate is responsible for assisting Managed Care Organization (MCO) members who elect to use the Consumer Directed Services (CDS) option. This role ensures a smooth onboarding process, facilitates communication between members, providers, and service coordinators, and monitors Electronic Visit Verification (EVV) data to mitigate risks and barriers to service utilization.

Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.

Completes work independently while executing good judgement and critical thinking skills while adhering to Department guideline, policies, and procedures.

Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.

Monitors Aetna Star Kids members enrolled in Consumer Directed Services to:

• Guide and support members through the CDS onboarding process, ensuring they understand their rights, responsibilities, and available resources.
• Act as a liaison between members, providers, and service coordinators to ensure seamless communication and service delivery.
• Monitor EVV data to track service utilization, identify potential issues, and proactively address risks or barriers.
• Provide education and assistance to members and their representatives regarding compliance with CDS program requirements.
• Assist with resolving discrepancies or concerns related to service deliver, billing, and provider participation.
• Maintain accurate records of interactions, interventions, and escalations to ensure compliance with MCO policies and regulatory requirements.
• Collaborate with internal and external stakeholders to improve the CDS experience for members.
• Participate in Quarterly Member Advisory Group.
• Coordinate with Financial Management Service Agencies (FMSAs).
• Accepts or assists and/or processes including inquiries, referrals, questions, and complaints or concerns directed at CDS.
• Provide oversight for all areas of CDS, including member pay payment issues, fraud allegations, and reporting of suspected fraud, waste and abuse (FWA) to appropriate entities.

Required Qualifications

• Strong communication and interpersonal skills with the ability to engage diverse populations
• Basic understanding of Medicaid managed care, consumer-directed services, and home and community based services
• Proficiency in data analysis and problem solving to monitor Electronic Verification systems effectively
• Ability to multi-task and manage priorities in a fast paced environment
• Electronic Visit Verification understanding and ability to monitor

Preferred Qualifications

• Prefer experience with customer service, case management/service coordination, or healthcare administration is a plus
• Bilingual(Spanish), not required but a plus

Education

• High school diploma or higher OR 3+ years equivalent experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $35.29

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/14/2025

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