Care Management Associate

Job not on LinkedIn

🔥 16 hours ago

🌵 Arizona, North Carolina, +1 more states – Remote

🌵 Arizona – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote

💵 $18 - $35 / 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

• Evaluate patients using targeted intervention business rules and processes to identify needed medical services • Make appropriate referrals to medical services staff and coordinate services according to the benefit plan • Communicate health care service delivery based on nurse or medical director outcomes and reviews • Perform non-medical research for establishing, maintaining, and closing open cases • Answer provider and member telephone calls, take accurate messages, and support electronic transmission review and referrals • Use internal tools to determine required review steps based on clinical requirements and plan guidelines • Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements • Coordinate internal and external communication to enhance medical management services • Obtain discharge dates and refer cases to the clinical team for additional follow-up • Perform initial review and triage of Care Team tasks • Identify admission reason, facility, and member product to apply intervention assessment tools • Use Aetna systems to build, research, and enter member information • Support development and implementation of care plans • Coordinate health care delivery under nurse or medical director direction, including participating providers and services • Assist with claims payment issue research and resolution • Support hospital care, case management, and quality management processes in compliance with applicable laws, regulations, URAQ/NCQA, CMSA standards, and company procedures • Protect member confidentiality and adhere to company policies • Complete work independently while exercising judgment, critical thinking, urgency, and flexibility

🎯 Requirements

• Must be within an hour of New Albany, Ohio, Phoenix, Arizona, or High Point, North Carolina • 2 years of experience in customer service, telemarketing and/or sales • Alternatively, 5+ years of equivalent relevant experience • Proficiency in typing for keying in information and navigating multiple systems • Experience with computers, including Microsoft Word, Outlook, and Excel • High school diploma or equivalent GED, or 5+ years equivalent experience • Ability to work long periods sitting and performing telephone and computer work • Adept problem-solving and decision-making skills • Data entry and documentation within member records preferred • Medical office experience preferred • Call center experience preferred • Medical terminology knowledge preferred • Strong telephonic communication skills preferred • Strong organizational skills and ability to prioritize time-sensitive tasks preferred • Effective verbal and written communication skills with customers and teammates 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, based on eligibility