Care Management Associate

This is a fully remote position, open to applicants in Kentucky, +3 more states.

📋 Description

• Conduct initial assessments and triage of members.

• Oversee population health member enrollment for child and family welfare demographics.

• Manage a caseload of low-tier members.

• Create Wellness Plans and provide relevant community resources.

• Analyze care gaps and implement health questionnaires.

• Make outbound calls to connect members with suitable community resources.

• Evaluate members using intervention guidelines and processes to determine necessary medical services.

• Refer members to medical services staff and coordinate the required services as per the benefit plan.

• Recognize indicators for referrals into Case Management, Disease Management, Mixed Services, and other Specialty Programs.

• Utilize Aetna systems to compile, research, and input member data.

• Coordinate the delivery of healthcare services under the supervision of a nurse or medical director.

• Facilitate communication with healthcare providers and team members.

• Conduct non-medical research to establish, maintain, and close active cases.

• Assist team members by answering calls, researching data, and aiding in problem-solving.

• Ensure accurate documentation that meets risk management, regulatory, and accreditation standards.

• Safeguard member confidentiality.

• Aid in the investigation and resolution of claims payment discrepancies.

• Complete comprehensive electronic records for each member interaction.

• Achieve daily metrics and deliverables while working autonomously.

• Engage in multidisciplinary team collaboration.

• Conduct ongoing outreach and encourage active participation.

⛳️ Requirements

• Must reside in Ohio, West Virginia, Kentucky, or Louisiana.

• 2-4 years of experience in the healthcare sector or working with foster care and child and family welfare populations.

• Strong communication, telephonic, and organizational skills; ability to manage multiple tasks and adapt to changes.

• Excellent customer service abilities.

• A minimum of 2 years’ demonstrated proficiency with personal computers, keyboarding, multi-system navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).

• Some in-state travel (5-10%) may be necessary; must have reliable transportation and be open to travel.

• Must successfully complete the CANS certification exam within the first 3 months of employment.

• High school diploma or G.E.D. is required.

• Motivational interviewing skills are preferred.

• Experience in a call center is preferred.

• Background in Managed Care is preferred.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.

• Mileage reimbursement according to company expense policies.

• A flexible work schedule may be available after 6 months of service, contingent on performance and attendance.