Care Management Associate

Job not on LinkedIn

🔥 1 hour 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%

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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 rules and processes • Identify needed medical services and make appropriate referrals • Coordinate required services according to benefit plans • Communicate health care service delivery based on nurse or medical director reviews • Perform non-medical research for establishing, maintaining, and closing open cases • Answer provider and member telephone calls and take accurate messages • Review electronic transmissions and make referrals as appropriate • Use internal tools to determine review steps based on clinical requirements and plan guidelines • Maintain 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 follow-up • Conduct initial review and triage of Care Team tasks • Identify admission reason, facility, and member product to apply 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 • Identify opportunities to use participating providers and services • Support hospital care, case management, and quality management processes • Assist with research and resolution of claims payment issues • Protect member confidentiality and comply with company policies, laws, and regulatory standards • Work independently using judgment and critical thinking while meeting quality and productivity standards

🎯 Requirements

• Must be within an hour of New Albany, Ohio, Phoenix, AZ, or High Point, NC • 2 years of experience in customer service, telemarketing and/or sales • Proficiency in typing and navigating multiple systems • Computer experience including Microsoft Word, Outlook, and Excel • High school diploma or equivalent GED • Alternatively, 5+ years of equivalent experience • 5+ years of prior relevant work experience • Problem-solving and decision-making skills • Ability to work extended periods sitting and performing telephone and computer work • Data entry and documentation within member records • Medical office experience preferred • Call center experience preferred • Knowledge of medical terminology preferred • Strong telephonic communication skills preferred • Strong organizational and prioritization skills preferred • Effective verbal and written communication skills preferred • Direct/hardwired internet connection within 7 feet of modem/router, with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet not permitted • Quiet, secure, private, compliant home workspace • Must work within the state and city where currently living • Ability to use multiple monitors and applications simultaneously • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues and contact IT when needed • Openness to learning 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 • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment including keyboard, monitor, computer, and headset • Remote work from home

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