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Position Summary

Aetna’s Medicaid Care Management Engagement Outreach Hub is a new initiative focused on prioritizing Medicaid member interaction, maximizing inbound and outbound touchpoints to solve members’ needs and create behavioral change. How we do this is through a dedicated and caring team of health care professionals who connect with passion, caring and behavioral interviewing techniques. This team has a drive to exceed the delivery of Medicaid Health care services. Focus is on the Hub’s efficiency and productivity efforts whereby the Care Management Associates interact and engage telephonically with members. Through the successful supports orchestrated by the Hub team, this comprehensive care coordination is a collaborative demonstration of innovative healthcare navigation and motivational health plan customer support representation. This is an exciting time to join Aetna, a CVS Health Company, in our journey to change the way healthcare is delivered today. We are health care innovators.

The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of our eligible members. Our Engagement Care Management Associates demonstrate a highly energetic blend of salesperson, healthcare navigator and health plan customer support representative. The Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers immediately through a warm transfer. By successfully enrolling members into care management, further supports the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness.

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 procedure/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.

Required Qualifications

- Must reside in the state of Florida

- 2 years of healthcare experience could be at a call center or in a doctors office environment.

- Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.

- Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude.

- 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, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).

- Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.

- Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically.

- Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Preferred Qualifications

- 2 plus years’ experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding) preferred.

- Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records preferred.

- Familiarity with basic medical terminology and concepts used in care management preferred.

- Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm.

- Strong organizational skills, including effective verbal and written communication skills.

- Bilingual (Spanish) preferred.

Education

High School Diploma or equivalent GED

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

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 jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/13/2024

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