Care Management Associate

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

📋 Description

• Facilitate the comprehensive coordination of the National Medical Excellence Program by managing inbound calls from the phone queue.

• Conduct intake of calls from providers or members.

• Utilize Aetna systems like MedCompass, HRP, ASD, CEC, ATV, and others to build, research, and enter member information.

• Execute non-medical research tasks, including eligibility verification, COB, and benefits verification.

• Ensure accurate and complete documentation while adhering to risk management, regulatory, and accreditation standards.

• Process referrals, conduct outreach calls, and input data.

• Collaborate with the clinical team, medical directors, claims, and contacting staff.

• Communicate with transplant financial coordinators at transplant centers.

• Initiate authorizations for kidney transplants in line with unit processes.

• Interact with members or providers concerning transplant services.

• Construct shell cases for transplant, cellular therapy, and gene therapy service requests and assign them for nurse review.

• Foster internal and external communication to improve medical management services.

• Safeguard member confidentiality and adhere to company confidentiality policies.

• Assist in the administration of the precertification process in alignment with relevant laws, regulations, NCQA standards, and company policies.

• Communicate with Aetna nurses and medical directors when processing transactions for members enrolled in the program.

• Engage in sedentary work involving extended periods of sitting, talking, hearing, and keying.

• Carry out other duties as assigned.

⛳️ Requirements

• Minimum of 2 years’ experience as a medical assistant, office assistant, or in a clinical/equivalent role.

• Proficient computer skills, including the Microsoft Office Suite, especially Excel.

• Ability to communicate effectively with diverse populations.

• Capacity to collaborate and work within a team environment.

• Flexibility and the ability to work independently.

• High School Diploma or equivalent GED is required.

• At least 1 year of prior insurance experience, preferably in a Call Center setting.

• Experience in Telephonic Customer Service.

• A minimum of 1 year of prior authorization experience.

• An Associate Degree is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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