Care Management Associate

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Assess patients through specific intervention business rules and processes.

• Determine necessary medical services and provide suitable referrals.

• Organize essential services in accordance with the benefit plan.

• Convey health care service delivery based on evaluations by nurses or medical directors.

• Conduct non-medical research for initiating, managing, and concluding open cases.

• Respond to provider and member phone inquiries and accurately record messages.

• Facilitate electronic transmission reviews and referrals.

• Utilize internal tools to ascertain required review steps in line with clinical requirements and plan guidelines.

• Ensure precise documentation that aligns with risk management, regulatory, and accreditation standards.

• Foster both internal and external communication to enhance medical management services.

• Acquire discharge dates and refer to the clinical team for follow-up actions.

• Conduct initial reviews and triage Care Team tasks.

• Identify reasons for admission, facilities, and member products to apply intervention assessment tools effectively.

• Leverage Aetna systems for building, researching, and entering member data.

• Assist in the development and execution of care plans.

• Coordinate health care delivery under the guidance of nurses or medical directors in suitable environments and at reasonable costs.

• Aid in the research and resolution of claims payment concerns.

• Support hospital care, case management, and quality management processes in accordance with relevant standards, laws, regulations, and company protocols.

• Safeguard member confidentiality.

• Execute work independently, utilizing judgment and critical thinking to meet quality and productivity benchmarks.

⛳️ Requirements

• A minimum of 2 years' experience in customer service, telemarketing, and/or sales.

• Proficient in typing and navigating multiple systems efficiently.

• Experience with computers, including Microsoft Word, Outlook, and Excel.

• High School diploma or equivalent GED.

• Must have or be able to acquire a direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speed of 25 Mbps for downloads and 3 Mbps for uploads.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, private, designated home work area that complies with CVS Health and HIPAA guidelines.

• Must reside and work within the state and city of current residence.

• Capability to use multiple monitors and navigate various applications simultaneously.

• Proficiency in using email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 or similar Google Workspace applications.

• Ability to access secure systems like VPN and EHR portals.

• Competence in following computer and information security protocols.

• Capacity to independently troubleshoot common technical issues.

• Requires extended periods of sitting along with phone and computer tasks.

• Preferred: experience in data entry and documentation within member records.

• Preferred: background in medical office settings.

• Preferred: call center experience.

• Preferred: knowledge of medical terminology.

• Preferred: strong telephonic communication abilities.

• Preferred: excellent organizational skills and the ability to prioritize time-sensitive tasks.

• Preferred: effective verbal and written communication skills.

• In the requisition details: high school diploma or 5+ years of equivalent experience; 5+ years of relevant work experience; strong problem-solving and decision-making abilities.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Company-provided equipment (keyboard, monitor, computer, headset, etc.).