Care Management Associate Member Connections

CVS Health•Work At Home-Louisiana, LA

2d•$19 - $42

About The Position

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. The Hub uses a dedicated team of health care professionals who connect with members through compassionate outreach and behavioral interviewing techniques, with a focus on efficiency and productivity. The Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of eligible members. The role blends member engagement, healthcare navigation, and health plan customer support. The Associate conducts direct outreach, facilitates case assignment, and connects identified members to care managers through warm transfers. Enrolling members into care management supports implementation of care plans and effective utilization of healthcare services. The Associate also supports team members by answering telephone calls, taking messages, researching information, and helping solve problems. The role requires compliance with policies, procedures, and regulatory standards; accurate and complete documentation; and protection of confidential member information.

Requirements

High school diploma plus experience.
Effective communication, telephonic, and organizational skills, including the ability to manage multiple priorities and adapt to change.
Ability to meet daily metrics with speed, accuracy, and a positive attitude.
Strong customer service skills, including attentiveness to customers, sensitivity to issues, and proactive identification and resolution of issues.
Ability to follow care management processes, including privacy and confidentiality requirements and applicable quality, regulatory, accreditation, and company standards.
Ability to complete detailed documentation of each member call in electronic records.
Ability to work independently, meet deliverables and deadlines, and demonstrate an outgoing, enthusiastic, and caring presence by telephone.
Ability to participate effectively in a multidisciplinary team with internal and external participants.

Nice To Haves

Two to four years of healthcare experience, such as in a medical office, hospital, or medical billing/coding.
Computer experience, including Microsoft Word, Outlook, and Excel, and data entry and documentation in member records.
Familiarity with basic medical terminology and concepts used in care management.
Flexibility to work occasional nights and weekends outside standard business hours, which can span from 8:00 a.m. to 8:00 p.m.
Strong organizational skills and effective verbal and written communication skills.
Bilingual Spanish skills.

Responsibilities

Conduct telephonic outreach to eligible Medicaid members and engage them in care management.
Facilitate case assignment and connect identified members to care managers through warm transfers.
Support enrollment in care management and the implementation of care plans to promote effective utilization of healthcare services.
Answer telephone calls, take messages, research information, and assist team members in solving problems.
Adhere to company policies, procedures, and regulatory standards.
Maintain accurate and complete documentation in electronic member records, meeting risk management, regulatory, and accreditation requirements.
Protect confidential member information and follow company confidentiality policies.
Meet daily metrics while completing required call actions with speed, accuracy, and efficiency.