Care Management Associate

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

📋 Description

• Assist in the thorough coordination of medical services

• Conduct intake, screening, and support the implementation of care plans for the Care Team

• Perform initial reviews and triage of tasks for the Care Team

• Determine reasons for admission, relevant facilities, and member products to apply intervention assessment tools

• Screen patients utilizing targeted intervention guidelines and processes

• Identify required medical services, make referrals, and coordinate services in line with benefit plans

• Monitor non-targeted cases to ensure appropriate discharge dates and outcomes

• Recognize and refer outlier cases to clinical personnel

• Identify triggers for referrals to Case Management, Mixed Services, and Specialty Programs

• Utilize Med Compass and other Aetna systems to build, research, and input member information

• Coordinate and arrange healthcare service delivery under the supervision of a nurse or medical director

• Seek opportunities to utilize participating providers and services at suitable costs

• Foster internal and external communication to improve medical management services

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

• Offer support services to team members

• Research information and assist with problem resolution

• Maintain precise documentation that meets risk management, regulatory, and accreditation standards

• Safeguard the confidentiality of member information

• Assist in the research and resolution of claims payment issues

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

⛳️ Requirements

• 2-4 years of experience in a healthcare environment, medical/health setting, medical billing, and coding

• Experience in a call center or customer service role

• Capability to work independently while meeting deliverables and deadlines

• Ability to achieve daily metrics with speed and accuracy

• Strong written and verbal communication skills

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

• Technical proficiency with the ability to navigate computer systems and digital tools effectively

• Capacity to collaborate effectively with clinical teams

• Excellent communication skills for engaging with providers and internal stakeholders

• Commitment to delivering high-quality service and supporting patient care outcomes

• High School Diploma or G.E.D.

• Ability to secure a direct/hardwired internet connection to a modem/router within 7 feet of the computer

• Minimum internet speeds of 25 Mbps download and 3 Mbps upload

• Quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA guidelines

• Must reside within the same state and city as the current residence

• Proficient in using multiple monitors and navigating various applications simultaneously

• Experience with Microsoft Office 365 applications or similar tools such as Google Workspace

• Ability to utilize secure systems such as VPN and EHR portals

• Capacity to manage strong passwords and identify suspicious emails or links

• Ability to troubleshoot common technical issues

• Willingness to learn new skills

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base pay

• 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.)