Care Management Associate

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Care Management Associate 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.

Responsibilities:

• Evaluates 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 by the benefit plan.
• Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director.
• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
• Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Ensures communication, both internally and externally, to enhance the effectiveness of medical management services.
• Assists in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
• Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.

Requirements:

• 2 years of experience in either customer service, telemarketing and/or sales
• Proficiency in typing for keying in information and navigating in multiple systems
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel
• Requires long periods of sitting and telephone and computer work.

Preferred Qualifications:

• Data entry and documentation within member records
• Medical office experience
• Call center experience
• Medical terminology knowledge
• Strong telephonic communication skills
• Strong organizational skills with an ability to prioritize tasks to meet time-sensitive deadlines
• Effective verbal and written communications skills with both customers and teammates

Work from Home Requirements:

• Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

Benefits:

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs