Care Manager

Job not on LinkedIn

🔥 24 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 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

• Supports comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services • Responsible for initial review and triage of Care Team tasks • Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools • Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan • Monitors non-targeted cases for entry of appropriate discharge date and disposition • Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff • Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs • Utilizes eTUMS and other Aetna systems to build, research and enter member information, as needed • Supports the Development and Implementation of Care Plans • Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense • Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., healthcare providers, and health care team members respectively) • Performs non-medical research pertinent to the establishment, maintenance and closure of open cases • Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems • Adheres to Compliance with PM Policies and Regulatory Standards • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements • Protects the confidentiality of member information and adheres to company policies regarding confidentiality • May assist in the research and resolution of claims payment issues • Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures

🎯 Requirements

• Minimum of 1-3+ years of experience in customer service, healthcare support, medical office, call center, care coordination, or another member-facing role • Demonstrated ability to deliver exceptional service to members, patients, customers, or providers by actively listening, assessing needs, and providing timely, accurate solutions • Experience managing member inquiries, resolving service-related issues, and coordinating with internal and external partners to achieve positive outcomes • Strong interpersonal, communication, and problem-solving skills with a commitment to member satisfaction and service excellence • Ability to navigate sensitive situations with empathy, professionalism, and a member-first approach • Proficiency with Microsoft Outlook, Word, Excel, and other technology tools used to support member communications, documentation, case tracking, and issue resolution

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility