Care Management Analyst

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🔥 0 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🧐 Business Analyst

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Review and triage Care Team tasks • Identify admission reasons, facilities, and member products to apply intervention assessment tools • Screen patients using intervention business rules and processes • Identify needed medical services, make referrals, and coordinate required services according to the benefit plan • Monitor non-targeted cases for appropriate discharge dates and dispositions • Identify and refer outlier cases to clinical staff • Identify triggers for referral into Case Management, Disease Management, and Mixed Services • Support development and implementation of care plans • Coordinate and arrange healthcare service delivery under nurse or medical director direction • Identify opportunities to use participating providers and services in appropriate settings and at appropriate expense • Promote internal and external communication with healthcare providers and team members • Perform non-medical research for establishing, maintaining, and closing open cases • Answer telephone calls, take messages, research information, and assist with problem-solving • Maintain accurate documentation meeting risk management, regulatory, and accreditation requirements • Protect member confidentiality and follow company confidentiality policies • Assist with researching and resolving claims payment issues • Support hospital care, case management, and quality management processes in compliance with applicable laws, regulations, URAQ, NCQA, CMSA standards, and company policies

🎯 Requirements

• Minimum of 1–3+ years of experience as a medical assistant, office assistant, or related healthcare/medical role • Strong customer service skills • Attention to members and providers • Sensitivity to issues • Proactive identification and resolution of issues • Medical office experience preferred • Medicaid experience preferred • Customer service experience preferred • Care coordination experience preferred • Technical skills preferred • High School diploma, G.E.D., or equivalent experience

🏖️ Benefits

• Comprehensive benefits package • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility