Case Manager Associate

Job not on LinkedIn

🔥 12 hours ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $18 - $35 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.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

• 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 • Refer patients to medical services staff and coordinate required services according to benefit plans • Monitor non-targeted cases for discharge dates and dispositions • Identify outlier cases and refer them to clinical staff • Identify triggers for referral to Case Management, Disease Management, Mixed Services, and Specialty Programs • Use eTUMS and other Aetna systems to build, research, and enter member information • Support development and implementation of care plans • Coordinate and arrange healthcare service delivery under nurse or medical director direction • Promote communication with healthcare providers and healthcare team members • Perform non-medical research for establishing, maintaining, and closing cases • Support team members by answering calls, taking messages, researching information, and solving problems • Maintain compliance with PM policies and regulatory standards • Maintain accurate documentation meeting risk management, regulatory, and accreditation requirements • Protect member confidentiality • Assist with research and resolution of claims payment issues • Support hospital care, case management, and quality management processes in compliance with applicable laws, regulations, URAQ, NCQA, and CMSA standards

🎯 Requirements

• Minimum of 1-3+ years experience as a medical assistant, office assistant, or related healthcare/medical role required • Strong customer service skills to coordinate service delivery • 1-3 years of end user experience with Microsoft Outlook, Word, and Excel • High School diploma, G.E.D. or equivalent experience • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure and private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Ability to use multiple monitors and navigate multiple 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 log in to secure systems such as VPN and EHR portals • Ability to follow computer security practices, including strong passwords and recognizing suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace environment evolves

🏖️ 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.)

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