Care Management Associate

CVS Health•Work At Home-Connecticut, CT

4d•$19 - $39•Remote

About The Position

The Care Management Associate supports the coordination of medical services, including Care Team intake, screening, and implementation of care plans to promote effective use of healthcare services and quality outcomes. The role performs initial review and triage of Care Team tasks; identifies the reason for admission, facility, and member product to apply intervention assessment tools; screens patients using targeted intervention rules and processes; makes referrals to medical services staff; and coordinates services according to the member’s benefit plan. The associate monitors non-targeted cases for appropriate discharge dates and dispositions, refers outlier cases to clinical staff, and identifies triggers for referral to Case Management, Mixed Services, and other specialty programs. The role uses Med Compass and other Aetna systems to research and enter member information. Under the direction of a nurse or medical director, the associate supports development and implementation of care plans by coordinating appropriate healthcare services and settings, including identifying opportunities to use participating providers and services. The role promotes communication with healthcare providers and internal care team members, conducts non-medical research related to open cases, and provides support services to team members. This is a work-from-home position. Employees must work from their confirmed city and state of residence and meet the specified internet, workspace, security, and technical requirements. The company provides computer equipment and other listed peripherals; employees provide their own desk or other workspace furniture. Training is scheduled sometime between 8:00 a.m. and 7:00 p.m. Eastern Time; the schedule changes after training.

Requirements

2–4 years of experience in a healthcare field, medical or health setting, or medical billing and coding.
Experience in a call center or customer service environment.
Ability to work independently and competently, meet deliverables and deadlines, and demonstrate an outgoing, enthusiastic, caring presence by phone.
Ability to meet daily metrics with speed and accuracy while maintaining a positive attitude and strong written and oral communication skills.
Ability to work efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems.
Technical proficiency and ability to navigate computer systems and digital tools efficiently.
Ability to work independently while collaborating effectively with clinical teams.
Excellent communication skills for interacting with providers and internal stakeholders.
Commitment to high-quality service and supporting patient care outcomes.
High school diploma or GED.
For work from home: have or obtain a direct, hardwired internet connection to a modem or router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Maintain a quiet, secure, private, organized, and distraction-free designated home workspace that complies with CVS Health and HIPAA guidelines and supports uninterrupted work.
Work from the state and city where the employee has confirmed they currently live.
Provide personal workspace furniture, such as a desk or standing desk, and comply with work-from-home requirements.
Be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
Be able to communicate through email, calendar invites, Teams messaging, and virtual meetings.
Have experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
Be able to access secure systems, use security practices such as locking unattended screens and managing strong passwords, and recognize suspicious emails or links.
Be able to troubleshoot common technical issues independently and contact IT for unresolved issues.
Be open to learning new skills as the workplace environment evolves.

Nice To Haves

Experience researching information and assisting in solving problems.
Knowledge of and adherence to PM policies and regulatory standards.
Ability to maintain accurate and complete documentation that meets risk management, regulatory, and accreditation requirements.
Ability to protect confidential member information and follow company confidentiality policies.
Ability to assist with researching and resolving claims payment issues.
Knowledge of hospital care, case management, and quality management processes and applicable laws and regulations, URAC and/or NCQA standards, and Case Management Society of America standards.
Ability to handle multiple assignments competently, accurately, and efficiently.
Customer service experience.
Knowledge of medical terminology.

Responsibilities

Perform initial review and triage of Care Team tasks.
Identify the principal reason for admission, facility, and member product to apply appropriate intervention assessment tools.
Screen patients using targeted intervention rules and processes to identify needed medical services.
Refer patients to medical services staff and coordinate required services in accordance with the benefit plan.
Monitor non-targeted cases for appropriate discharge dates and dispositions.
Identify and refer outlier cases, such as length-of-stay cases, to clinical staff.
Identify triggers for referral to Case Management, Mixed Services, and other specialty programs.
Use Med Compass and other Aetna systems to build, research, and enter member information.
Support the development and implementation of care plans.
Coordinate and arrange healthcare service delivery under the direction of a nurse or medical director, identifying appropriate settings and participating providers and services.
Promote communication with healthcare providers and internal healthcare team members to support effective medical management.
Conduct non-medical research related to establishing, maintaining, and closing open cases.
Provide support services to team members.