CVS Health is looking for a Care Management Associate to join our OhioRISE initiative. This full-time remote telework position manages enrollment for Children’s Specialty programs serving foster care, child welfare, and children with special healthcare needs. You will support comprehensive medical service coordination, including intake, screening, and wellness plan implementation.
What You'll Do
- Complete initial review and triage of members.
- Manage population health member enrollment for child and family welfare programs.
- Manage a low-tier member caseload.
- Develop wellness plans, provide community resources, review gaps in care, administer health questionnaires, and address child welfare goals.
- Complete outbound calls to identify and engage appropriate community resources.
- Screen members using targeted intervention rules to identify needed medical services and make referrals.
- Identify triggers for referral into Aetna's Case Management, Disease Management, and other Specialty Programs.
- Utilize Aetna systems to build, research, and enter member information.
- Support the development and implementation of wellness plans, coordinating service delivery under clinical direction.
- Promote communication to enhance medical management services.
- Perform non-medical research for case management.
- Provide team support by answering calls, researching information, and assisting with problem-solving.
- Adhere to compliance policies and regulatory standards.
- Maintain accurate and complete documentation meeting risk management and accreditation requirements.
- Protect member information confidentiality per company policy.
- Assist in research and resolution of claims payment issues.
- Support hospital care, case management, and quality management processes.
- Demonstrate effective communication and organization, managing multiple priorities.
- Meet daily metrics with speed, accuracy, and a positive attitude.
- Apply strong customer service skills to coordinate service delivery.
- Complete thorough documentation of each member call in the electronic record.
- Work independently to meet deliverables and deadlines with an enthusiastic, caring telephonic presence.
- Participate effectively in multi-disciplinary teams.
- Conduct outreach and manage persistent outreach to promote active connection.
What We're Looking For
- Must reside in Ohio.
- 2-4 years of experience in healthcare or working with foster, child, and family welfare populations.
- Effective communication, telephonic, and organization skills with ability to manage multiple priorities and adapt to change.
- Strong customer service skills with attention to detail and proactive issue resolution.
- 2+ years of proficiency with personal computers, multi-system navigation, and MS Office Suite.
- Some in-state travel (5-10%) may be required; reliable transportation is necessary.
- Must pass the CANS certification exam within the first 3 months of employment.
- High school diploma or G.E.D.
Nice to Have
- Motivational interviewing skills.
- Call Center experience.
- Managed Care experience.
Technical Stack
- MS Office Suite (Teams, Outlook, Word, Excel).
- Aetna systems.
Benefits & Compensation
- Compensation: $18.50 - $31.72 per hour.
- Affordable medical plan options, a 401(k) with company match, and an employee stock purchase plan.
- No-cost wellness programs including screenings, tobacco cessation, weight management, counseling, and financial coaching.
- Comprehensive benefits including paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, and more.
Work Mode
This is a full-time remote telework position. Candidates must reside in Ohio.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered in accordance with all applicable laws.
