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
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, 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.

· Hours of Operation Training and Work schedule will be between the hours of 8:00 AM-8:00 PM ET, Training will be for approximately 4 to 8 weeks 8-hour training shift between this timeframe within your designated time zone. Training will be Monday thru Friday 40 hours a week until they show they are proficient in processes prior to transition to the weekend shift.

· Position is for a Weekend Care Management Associate position 10 hour days (4 days per week) with schedule of 7am to 5:30pm in your respective time zone, Saturday - Tuesday.

· Weekend and Holiday hours will be required.
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.

· This role requires the ability to work efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems.

· Technically proficient, with the ability to navigate computer systems, and digital tools efficiently

· Ability to work independently while collaborating effectively with clinical teams.

· Excellent communication skills for interacting with providers and internal stakeholders.

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.

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.

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