Care Management Associate

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

📋 Description

• Oversee medical services, including managing incoming and outgoing calls.

• Assess eligibility and benefits while initiating pre-certification cases.

• Grant approvals for cases or escalate them to nursing staff for further evaluation.

• Analyze patients utilizing designated intervention business rules and procedures.

• Determine necessary medical services, facilitate referrals, and coordinate services in line with benefit plans.

• Relay health care service delivery based on outcomes and reviews from nursing or medical director.

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

• Respond to calls from providers and members, take precise messages, review electronic communications, and make referrals.

• Utilize internal tools to identify necessary review procedures based on clinical standards and plan guidelines.

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

• Foster communication internally and externally to enhance medical management services.

• Acquire discharge dates and facilitate appropriate referrals for further clinical follow-up.

• Operate independently when required while adhering to departmental guidelines, policies, and procedures.

• Achieve performance standards in terms of quality and quantity in a rapidly evolving environment.

⛳️ Requirements

• Candidates must reside in Arizona.

• A minimum of 2 years’ experience as a medical assistant, office assistant, or in a related position.

• At least 6 months of experience in a call center environment.

• High School Diploma or equivalent GED is required.

• Strong communication, telephonic, and organizational skills are essential.

• Knowledge of basic medical terminology and care management concepts is preferred.

• Excellent customer service abilities.

• Proficient in using both internal and external computer systems.

• Competent in Excel and Microsoft Word.

• Availability to work Monday through Friday, from 8:30 AM to 5:00 PM Arizona time.

🏝️ 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 that support physical, emotional, and financial well-being, depending on eligibility.