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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

As a Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of health services service. Promotes/supports quality effectiveness of Healthcare Services.

Position Responsibilities:  

• Responsible for initial review and triage of Care Teams tasks.
• Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
• Screens 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 in accordance with the benefit plan.
• Monitors non-targeted cases for entry of appropriate discharge date and disposition.
• Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Utilizes Med Compass and Aetna systems to build, research and enter member information as needed.
• Support the development and Implementation of Care Plans.
• Coordinates and arranges for health care service delivery under the direction of nurse or medical direction in the 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).
• Perform non-medical research pertinent to the establishment, maintenance and closure of open cases.
• Provides support services to team member.
• 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 law and regulation, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.

Training Schedule: 8:00 AM - 4:30 PM EST (Regular Shift will be different once training is completed).

Hours of Operation: 8:00 AM-8:00 PM ET, 8 hour shift between this timeframe.  Usually the schedule falls within 8-5PM within your designated time zone. 

Required Qualifications

• 2-4 years of experience within the healthcare field, medical/health setting, medical billing and coding.
• Experience in call center or customer service environment.
• Ability to work independently, meeting deliverables and deadlines with demonstrating and outgoing, enthusiastic and caring presence telephonically.
• Demonstrates ability to meet daily metrics a with speed, accuracy and a positive attitude and strong written and oral communication skills.

 

Preferred Qualifications

• Researching information and assisting in solving problems
• Adheres to Compliance with PM 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
• Demonstrated ability to handle multiple assignments, accurately, and efficiently.
• Knowledge of Medical Terminology.

 

Education

• High School Diploma or G.E.D.

 

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: 10/28/2024

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