Care Management Associate

This is a fully remote position, open to applicants in Alabama, +44 more locations.

📋 Description

• Review, intake, screen, and triage tasks related to Utilization Management and Care Management.

• Collect, research, and verify information regarding members, providers, facilities, admissions, authorizations, and other case details.

• Prepare cases and assign tasks to nurses, medical directors, and other clinical collaborators.

• Conduct outbound outreach to providers and facilities.

• Monitor ongoing work for any missing information, discharge details, documentation requirements, or follow-up actions.

• Identify triggers for referrals or transitions to Care Management, Disease Management, Transition of Care, and various other clinical programs.

• Document calls, actions taken, research findings, outcomes, and follow-up activities within designated systems.

• Navigate through multiple systems, work queues, provider portals, and technological tools while ensuring data accuracy.

• Conduct non-clinical research to establish, maintain, process, and conclude cases.

• Manage assigned responsibilities within designated turnaround times and escalate any barriers or aging tasks.

• Meet productivity and quality standards while fostering positive experiences for members, providers, and internal partners.

• Safeguard PHI/PII and adhere to relevant requirements.

⛳️ Requirements

• A minimum of 2 years of experience in health insurance, healthcare operations, provider services, medical office operations, Utilization Management/Care Management support, prior authorization, or a similar healthcare setting.

• High school diploma or GED required.

• Strong attention to detail.

• Effective time management skills.

• Capability to work across multiple systems, applications, and work queues.

• Ability to adhere to established workflows and business rules.

• Flexibility to adapt to evolving processes and technologies.

• Capacity to meet turnaround times, productivity, quality, and documentation standards.

• Skill in protecting PHI/PII and ensuring compliance with HIPAA, privacy, security, regulatory, accreditation, and company standards.

• An associate degree or higher in healthcare, business, or a related field is preferred.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.