Care Management Associate, Engagement Hub (Must reside in Maryland)

CVS Health • Milesburg, PA

1d • $19 - $32

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Aetna’s Medicaid Care Management Engagement Outreach Hub is a new initiative focused on prioritizing Medicaid member interaction, maximizing inbound and outbound touchpoints to solve members’ needs and create behavioral change. How we do this is through a dedicated and caring team of health care professionals who connect with passion, caring and behavioral interviewing techniques. This team has a drive to exceed the delivery of Medicaid Health care services. Focus is on the Hub’s efficiency and productivity efforts whereby the Care Management Associates interact and engage telephonically with members. Through the successful supports orchestrated by the Hub team, this comprehensive care coordination is a collaborative demonstration of innovative healthcare navigation and motivational health plan customer support representation. This is an exciting time to join Aetna, a CVS Health Company, in our journey to change the way healthcare is delivered today. We are health care innovators. The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of our eligible members. Our Engagement Care Management Associates demonstrate a highly energetic blend of salesperson, healthcare navigator and health plan customer support representative. The Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers immediately through a warm transfer. By successfully enrolling members into care management, further supports the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness. Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems. Adheres to Compliance with policies and procedure/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.

Requirements

• Must reside in Maryland
• 2 years’ experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding)
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records
• Familiarity with basic medical terminology and concepts used in care management
• Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm.
• Strong organizational skills, including effective verbal and written communication skills.

Nice To Haves

• Bilingual (Spanish) preferred, must have ability to pass a written and oral exam.
• Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
• Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).
• Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
• Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Responsibilities

• direct member outreach and engagement
• facilitating case assignment
• connecting identified members to care managers immediately through a warm transfer
• successfully enrolling members into care management
• supports the implementation of care plans to promote effective utilization of healthcare services
• promoting and supporting quality effectiveness
• Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems
• Adheres to Compliance with policies and procedure/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.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees