Care Management Associate

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:

Must be within an hour of New Albany, Ohio, Phoenix, AZ, High Point, NC.

Training is 4 weeks, then 8 weeks with a preceptor.

8 hour shifts

Start Times Available:

Variable per location

• Evaluates patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan. Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director
• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
• Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
• Assist in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
• Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, 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.

The Care Management Associate 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. Promotes/supports quality effectiveness of Healthcare Services.

The Care Management Associate position duties include (not all encompassing):

-Responsible for initial review and triage of Care Team tasks.

-Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools.

-Utilizes Aetna systems to build, research and enter member information, as needed.

-Supports the development and implementation of Care Plans.

-Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services

-Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively)

-Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases

-Provides support services to team members by answering telephone calls, taking messages, researching information, and assisting in solving problems.

-Adheres to compliance with policies and 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.

-May assist in the research and resolution of claims payment issues.

-Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.

Required Qualifications

• •2 years of experience in either customer service, telemarketing and/or sales
• •Proficiency in typing for keying in information and navigating in multiple systems
• •Experience with computers including knowledge of Microsoft Word, Outlook, and Excel
• •Requires long periods of sitting and telephone and computer work.

Preferred Qualifications

• •Data entry and documentation within member records
• •Medical office experience
• •Call center experience
• •Medical terminology knowledge
• •Strong telephonic communication skills
• •Strong organizational skills with an ability to prioritize tasks to meet time-sensitive deadlines
• •Effective verbal and written communications skills with both customers and teammates

Education

High School diploma, or equivalent GED

Requisition Job Description

• Primary Job Duties & Responsibilities
• Evaluates patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan. Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director
• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
• Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
• Assist in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
• Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, 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.

• Education
• High school diploma or 5+ years equivalent experience.

• Prior Relevant Work Experience
• 5+ years

• Essential Qualifications
• Adept at problem solving and decision making skills

Job Description

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 download 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 req