Care Management Associate

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

📋 Description

• Facilitate the thorough coordination of medical services, encompassing Care Team intake, screening, and care plan execution.

• Evaluate and prioritize Care Team assignments.

• Determine reasons for admission, facilities, and member products to utilize intervention assessment tools.

• Screen patients applying targeted intervention rules and processes to pinpoint necessary medical services.

• Refer patients to medical services personnel and coordinate services per the benefit plan.

• Oversee non-targeted cases for discharge dates and outcomes.

• Recognize outlier cases and triggers for referral to Aetna Case Management, Mixed Services, and Specialty Programs.

• Utilize Med Compass and Aetna systems to compile, investigate, and input member data.

• Assist in the creation and execution of care plans.

• Coordinate healthcare service delivery under the guidance of nursing or medical leadership, identifying participating providers and cost-effective services.

• Foster internal and external communication with healthcare providers and team members.

• Conduct non-medical research for establishing, maintaining, and closing open cases.

• Provide assistance to team members in various tasks.

• Aid in researching and resolving claims payment discrepancies.

• Support hospital care, case management, and quality management processes in accordance with laws, regulations, URAQ, NCQA, CMSA standards, and company policies.

• Participate in training Monday through Friday, 40 hours per week, for approximately 4-8 weeks from 8:00 AM to 8:00 PM ET.

• Follow the weekend schedule from Saturday to Tuesday, 7:00 AM to 5:30 PM in the corresponding time zone, totaling four 10-hour days.

⛳️ Requirements

• 2-4 years of experience in the healthcare sector, including medical/health settings, medical billing, and coding.

• Background in a call center or customer service setting.

• Capability to work autonomously, meet deliverables and deadlines, and exhibit an outgoing, enthusiastic, and caring demeanor over the phone.

• Ability to achieve daily metrics with efficiency and precision while maintaining a positive outlook.

• Strong verbal and written communication skills.

• Proficient in working efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems.

• Technical adeptness in navigating computer systems and digital tools.

• Capacity to work independently while effectively collaborating with clinical teams.

• Excellent communication skills for engaging with providers and internal stakeholders.

• High School Diploma or G.E.D. is required.

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

• Designated home work location must be quiet, secure, and private, compliant with CVS Health and HIPAA standards.

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

• Personal workspace furniture suitable for prolonged desk work must be provided.

• Ability to utilize multiple monitors and applications simultaneously.

• Proficient in the use of email, calendar invites, Teams messaging, and virtual meetings.

• Familiarity with Microsoft Office 365 applications or similar Google Workspace tools.

• Ability to access secure systems such as VPN and EHR portals, follow computer security protocols, and identify suspicious emails or links.

• Capable of troubleshooting common technical issues independently.

• Availability on weekends and holidays is necessary.

• Knowledge of medical terminology is preferred.

• Ability to research information and assist in problem-solving is preferred.

• Compliance with PM policies and regulatory standards is preferred.

• Ability to maintain accurate documentation that meets risk management, regulatory, and accreditation standards is preferred.

• Ability to safeguard confidential member information is preferred.

• Capacity to manage multiple assignments accurately and efficiently is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program 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 (keyboard, monitor, computer, headset, etc.).