Care Management Associate

CVS Health • Dallas, TX

78d • $18 - $42

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. As a Care Management Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. You will be responsible for initial review and triage of Care Team tasks, identifying the principle reason for admission, facility, and member product to correctly apply intervention assessment tools. You will screen 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 in accordance with the benefit plan. Additionally, you will monitor non-targeted cases for entry of appropriate discharge date and disposition, identify and refer outlier cases to clinical staff, and utilize Med Compass and other Aetna systems to build, research and enter member information as needed.

Requirements

• 2-4 years of experience in healthcare field, medical/health setting, medical billing and coding.
• Experience in call center or customer service environment.
• Ability to work independently and competently, meeting deliverables and deadlines.
• Demonstrate an outgoing, enthusiastic and caring presence telephonically.
• Ability to meet daily metrics with speed, accuracy and a positive attitude.
• Strong written and oral communication skills.

Nice To Haves

• Experience in researching information and assisting in solving problems.
• Adherence to Compliance with PM Policies and Regulatory Standards.
• Ability to maintain accurate and complete documentation of required information.
• Experience in assisting in the research and resolution of claims payment issues.
• Support the administration of hospital care, case management and quality management processes.
• Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
• Customer service experience and knowledge of Medical Terminology.

Responsibilities

• Support comprehensive coordination of medical services including Care Team intake and screening.
• Promote/support quality effectiveness of Healthcare Services.
• Responsible for initial review and triage of Care Team 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 to clinical staff.
• Identify triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Utilize Med Compass and other Aetna systems to build, research and enter member information.
• Support the Development and Implementation of Care Plans.
• Coordinate and arrange for health care service delivery under the direction of nurse or medical director.
• Promote communication 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.

Benefits

• Affordable medical plan options.
• 401(k) plan including matching company contributions.
• Employee stock purchase plan.
• No-cost programs for wellness screenings, tobacco cessation and weight management.
• Confidential counseling and financial coaching.
• Paid time off and flexible work schedules.
• Family leave and dependent care resources.
• Colleague assistance programs and tuition assistance.
• Retiree medical access and many other benefits depending on eligibility.

What This Job Offers

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