Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary:

• Support comprehensive coordination of medical services including Care Team intake and outreach, screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
• Promotes/supports quality effectiveness of Healthcare Services.
• Responsible for initial review and outreach tasks.
• Tracks Medicaid redetermination and researches eligibility issues.
• Tracks and ensures Level of Care compliance standards set by the State.
• Utilizes Dynamo, QNXT and other Aetna systems to build, research and enter member information, as needed.
• Assists Case Managers with coordination of benefits 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 contract requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Create authorizations, outreach providers, bridge service gaps, assist with claims resolution and monitor authorization & claims reports.

Required Qualifications :

• 1+ years experience as a medical assistant, office assistant or member services representative in a healthcare setting.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Preferred Qualifications:

• Bilingual - Spanish
• 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.
• Experience with long term care, managed care or medical care.
• Effective communication, telephonic and organization skills.
• Familiarity with basic medical terminology and concepts used in care management.
• Strong customer service skills to coordinate service delivery including attention
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Education:

• High School diploma or equivalent

Pay Range

The typical pay range for this role is:

$18.50 - $31.72

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/22/2024

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