Care Management Associate

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $18 - $38 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Support comprehensive coordination of medical services, including Care Team intake, screening, and care plan implementation • Review and triage Care Team tasks • Identify admission reasons, facilities, and member products to apply intervention assessment tools • Screen patients using targeted intervention rules and processes to identify needed medical services • Refer patients to medical services staff and coordinate services according to the benefit plan • Monitor non-targeted cases for discharge dates and dispositions • Identify outlier cases and triggers for referral to Aetna Case Management, Mixed Services, and Specialty Programs • Use Med Compass and Aetna systems to build, research, and enter member information • Support development and implementation of care plans • Coordinate healthcare service delivery under nurse or medical direction and identify participating providers and cost-effective services • Promote internal and external communication with healthcare providers and team members • Perform non-medical research for establishing, maintaining, and closing open cases • Provide support services to team members • Assist with researching and resolving claims payment issues • Support hospital care, case management, and quality management processes in compliance with laws, regulations, URAQ, NCQA, CMSA standards, and company policies • Complete training Monday through Friday, 40 hours per week, for approximately 4-8 weeks during 8:00 AM-8:00 PM ET • Work the weekend schedule Saturday-Tuesday, 7:00 AM-5:30 PM in the respective time zone, totaling four 10-hour days

🎯 Requirements

• 2-4 years of experience within the healthcare field, medical/health setting, medical billing, and coding • Experience in a call center or customer service environment • Ability to work independently, meet deliverables and deadlines, and demonstrate an outgoing, enthusiastic and caring presence telephonically • Ability to meet daily metrics with speed and accuracy and maintain a positive attitude • Strong written and oral communication skills • Ability to work efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems • Technical proficiency navigating computer systems and digital tools • Ability to work independently while collaborating effectively with clinical teams • Excellent communication skills for interacting with providers and internal stakeholders • High School Diploma or G.E.D. • Ability to obtain 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 permitted • Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide own workspace furniture suitable for extended desk work • Ability to use multiple monitors and applications simultaneously • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace tools • Ability to access secure systems such as VPN and EHR portals, follow computer security practices, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Weekend and holiday availability • Knowledge of medical terminology preferred • Ability to research information and assist in solving problems preferred • Compliance with PM policies and regulatory standards preferred • Ability to maintain accurate documentation meeting risk management, regulatory, and accreditation requirements preferred • Ability to protect confidential member information preferred • Ability to handle multiple assignments accurately and efficiently preferred

🏖️ 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 • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.)