Remote Medical Chart Reviewer Jobs in Decatur, IL

CVS Health Aetna has an opportunity for a full-time Care Management Associate (CMA). In this role, you will support the coordination of medical and social services for members by assisting with care team intake, task triage, outreach, and care plan implementation.

The CMA plays a key role in promoting effective utilization of healthcare services, supporting quality outcomes, and ensuring compliance with regulatory and accreditation standards.

• Review, prioritize, and triage incoming Care Team tasks to ensure timely follow-up and resolution
• Screen members using established guidelines and business rules to identify care needs and required services
• Initiate referrals to Case Management, Disease Management, LTSS, and other specialty programs as appropriate
• Conduct outreach to members, providers, and care team partners to support care coordination efforts
• Utilize internal systems to document member information, outreach, and case activity accurately and timely
• Support the development and implementation of member care plans under the direction of clinical staff
• Coordinate healthcare services and assist in identifying in-network, cost-effective care options
• Perform non-clinical research to support case development, maintenance, and closure
• Communicate effectively with internal teams, providers, and members to facilitate care delivery
• Provide administrative and operational support, including call handling, issue resolution, and task follow-up
• Maintain accurate, complete, and audit-ready documentation in compliance with company policies and regulatory requirements
• Adhere to all compliance standards, including CMS, NCQA, URAC, and internal quality guidelines

• 2-4 years of experience in a healthcare setting (e.g., medical assistant, office assistant, care coordination support)
• Strong computer proficiency, including Microsoft Word and Excel
• Ability to navigate multiple systems and manage tasks efficiently in a fast-paced environment

• Strong verbal and written communication skills, including telephonic outreach
• Knowledge of basic medical terminology and care management concepts
• Excellent organizational and time management skills with attention to detail
• Customer-focused approach with the ability to resolve issues proactively
• Ability to collaborate effectively within a multidisciplinary team

• High School Diploma or GED required

• 100% remote position
• Must maintain a dedicated, distraction-free workspace
• Candidates must have reliable childcare or dependent care arrangements during working hours
• Ability to manage a high-volume workload and meet productivity and documentation requirements