Legal Case Manager
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Job Description
Legal Case Manager reviewing PHI access and disclosure requests for CVS Health’s Aetna healthcare business. Ensuring HIPAA, privacy, and authorization compliance.
Responsibilities:
- Review, research, and process requests for member claims records involving Protected Health Information (PHI)
- Process and fulfill requests submitted to Aetna seeking access to member PHI
- Ensure legal, regulatory, privacy, and authorization requirements are satisfied before records are disclosed
- Review and validate request documentation to determine eligibility for disclosure
- Manage and process subpoenas, court orders, law enforcement requests, regulatory inquiries, legal access requests, member and provider authorizations, personal representative requests, and other legally permitted disclosures
- Research and resolve complex or non-routine member rights, disclosure, and privacy requests
- Escalate matters requiring legal, compliance, or privacy review
- Ensure confidentiality and security of sensitive member information while adhering to established policies, procedures, and internal controls
Requirements:
- Working knowledge of problem solving and decision making skills
- 2-5+ years’ work experience with Protected Health Information (PHI)
- Excellent verbal and written communication skills
- Working knowledge of HIPAA Privacy Rule requirements
- Experience reviewing and interpreting legal documents, subpoenas, court orders, authorizations, and regulatory correspondence
- High School Diploma or Equivalent Experience (REQUIRED)
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
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