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
Training Schedule anytime between: 8:00 am - 7:00 pm EST (this will change once they are out of training).

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 healthcare services. Promotes/supports quality effectiveness of Healthcare

Services. Responsible for initial review and triage of Care Team 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 other 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 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.

Required Qualifications
• 2-4 years of experience healthcare field, medical/health setting, medical billing, and coding

• Experience in call center or customer service environment

• Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring

presence telephonically

• Demonstrates ability to meet daily metrics with speed, accuracy, 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.

• Commitment to delivering high-quality service and supporting patient care outcomes.

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.
• 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.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. Customer service experience, 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.

• 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

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