CVS Health is hiring a Care Management Associate to support the comprehensive coordination of medical services, including Care Team intake, screening, and implementation of care plans. In this role, you will promote effective utilization and quality of healthcare services as part of our mission to transform healthcare.

What You'll Do

Responsible for initial review and triage of Care Teams tasks.
Identify principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
Screen patients using targeted intervention business rules and processes to identify needed medical services.
Make appropriate referrals to medical services staff and coordinate required services in accordance with the benefit plan.
Monitor non-targeted cases for entry of appropriate discharge date and disposition.
Identify and refer outlier cases (e.g., Length of Stay) to clinical staff.
Identify triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Utilize Med Compass and Aetna systems to build, research and enter member information as needed.
Support the development and implementation of Care Plans.
Coordinate and arrange for health care service delivery under the direction of nurse or medical direction in the appropriate setting.
Promote communication, both internally and externally to enhance effectiveness of medical management services.
Perform non-medical research pertinent to the establishment, maintenance and closure of open cases.
Provide support services to team members.
May assist in the research and resolution of claims payment issues.
Support the administration of hospital care, case management and quality management processes in compliance with laws, regulations, and company policy.

What We're Looking For

2-4 years of experience within the healthcare field, a medical/health setting, or medical billing and coding.
Experience in a call center or customer service environment.
Ability to work independently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic, and caring presence telephonically.
Demonstrated ability to meet daily metrics with speed, accuracy, a positive attitude, and strong written and oral communication skills.
High School Diploma or G.E.D.

Nice to Have

Experience researching information and assisting in solving problems.
Adherence 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.
Demonstrated ability to handle multiple assignments accurately and efficiently.
Knowledge of Medical Terminology.

Technical Stack

Med Compass
Aetna systems

Benefits & Compensation

Compensation: $18.50 - $42.35 per hour
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access