Care Management Associate

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Assess patients utilizing specific intervention rules and processes.

• Determine necessary medical services and facilitate appropriate referrals.

• Organize required services in accordance with benefit plans.

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

• Conduct non-medical research for the establishment, maintenance, and closure of open cases.

• Handle provider and member phone inquiries, ensuring accurate message-taking.

• Review electronic communications and make referrals as needed.

• Utilize internal tools to ascertain review steps according to clinical requirements and plan guidelines.

• Ensure comprehensive documentation that complies with risk management, regulatory, and accreditation standards.

• Facilitate both internal and external communications to improve medical management services.

• Gather discharge dates and refer cases to the clinical team for follow-up.

• Perform initial reviews and triage Care Team tasks.

• Identify the reason for admission, the facility, and member products to utilize assessment tools.

• Leverage Aetna systems to build, research, and input member data.

• Aid in the development and execution of care plans.

• Coordinate health care delivery under the guidance of a nurse or medical director.

• Spot opportunities to utilize participating providers and services.

• Support hospital care, case management, and quality management processes.

• Assist in researching and resolving claims payment issues.

• Safeguard member confidentiality and adhere to company policies, laws, and regulatory standards.

• Operate independently, exercising judgment and critical thinking while upholding quality and productivity standards.

⛳️ Requirements

• Must reside within an hour of New Albany, Ohio, Phoenix, AZ, or High Point, NC.

• Minimum of 2 years of experience in customer service, telemarketing, and/or sales.

• Proficient in typing and navigating multiple systems effectively.

• Computer literacy including Microsoft Word, Outlook, and Excel.

• High school diploma or equivalent GED is required.

• Alternatively, a minimum of 5 years of relevant experience may be considered.

• At least 5 years of prior relevant work experience is preferred.

• Strong problem-solving and decision-making capabilities.

• Capacity to work for extended periods while sitting and performing telephone and computer tasks.

• Proficient in data entry and documentation within member records.

• Experience in a medical office setting is preferred.

• Call center experience is preferred.

• Familiarity with medical terminology is preferred.

• Excellent telephonic communication skills are preferred.

• Strong organizational and prioritization skills are preferred.

• Effective verbal and written communication skills are preferred.

• Direct/hardwired internet connection within 7 feet of the modem/router, with a minimum of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not acceptable.

• A quiet, secure, private, and compliant home workspace is necessary.

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

• Ability to use multiple monitors and applications concurrently.

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

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

• Capability to access secure systems such as VPN and EHR portals.

• Ability to follow computer security protocols, manage strong passwords, and identify suspicious emails or links.

• Aptitude for troubleshooting common technical problems and contacting IT when necessary.

• Willingness to learn new skills.

🏝️ Benefits

• Bonus, commission, or short-term incentive program through CVS Health, 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, including keyboard, monitor, computer, and headset.

• Opportunity for remote work from home.