Care Management Associate

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

📋 Description

• Oversee enrollment for the Children’s Specialty program as well as for child and family welfare population health members.

• Manage a caseload of low-tier members.

• Conduct initial reviews of members and perform triage.

• Create Wellness Plans and provide access to community resources.

• Assess gaps in care and administer health questionnaires.

• Execute outbound calls to locate and engage community resources.

• Screen members to determine required medical services, make referrals, and coordinate care.

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

• Utilize Aetna systems for building, researching, and entering member information.

• Coordinate healthcare service delivery under the guidance of a nurse or medical director.

• Foster communication internally and externally with healthcare providers and team members.

• Conduct non-medical research for open case management.

• Assist team members by answering calls, researching information, and resolving issues.

• Ensure accurate documentation and safeguard member confidentiality.

• Aid in the research and resolution of claims payment discrepancies.

• Complete comprehensive electronic-record documentation for each member interaction.

• Meet daily metrics, deliverables, and deadlines.

• Participate in multidisciplinary teams and engage in ongoing outreach efforts.

⛳️ Requirements

• Must reside in Ohio.

• 2–4 years of experience in the healthcare field or working with foster and child and family welfare populations.

• Strong communication, telephonic, and organizational skills.

• Ability to manage multiple priorities and adapt to changing circumstances.

• Excellent customer service abilities.

• At least 2 years of demonstrated proficiency with personal computers, keyboarding, multi-system navigation, and applications in the MS Office Suite (Teams, Outlook, Word, Excel, etc.).

• Reliable transportation and willingness to travel within the state as necessary.

• Some in-state travel (5–10%) may be required.

• Must successfully complete the CANS certification exam within the first 3 months of employment.

• Preferred skills include motivational interviewing.

• Previous Call Center experience is preferred.

• Managed Care experience is preferred.

• High school diploma or G.E.D. is required.

🏝️ 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.

• Flexible work schedule may be available after 6 months of service, contingent on performance and attendance.

• Mileage reimbursement in accordance with the company expense reimbursement policy.