Care Management Associate

CVS Health•Work At Home-Arizona, AZ

3d•$19 - $35

About The Position

The Care Management Associate (CMA) supports the coordination of medical services, including intake and outgoing calls, and works closely with case management and utilization management teams. The role reviews eligibility and benefits, opens pre-certification cases, and either approves cases or sends them to nursing staff for review. The position is open to candidates located in Arizona and follows a Monday-through-Friday schedule from 8:30 AM to 5:00 PM Arizona time.

Requirements

At least 2 years of experience as a medical assistant, office assistant, or in a related role.
At least 6 months of call center experience.
High school diploma or equivalent GED.

Nice To Haves

Effective communication, telephonic, and organizational skills.
Familiarity with basic medical terminology and concepts used in care management.
Strong customer service skills, including attentiveness, sensitivity to issues, proactive issue identification, and resolution to promote positive outcomes for members.
Computer literacy and ability to navigate internal and external computer systems, including Excel and Microsoft Word.

Responsibilities

Evaluate patients using targeted intervention business rules and processes to identify needed medical services, make referrals to medical services staff, and coordinate services covered by the benefit plan.
Communicate health care service delivery as required based on outcomes or reviews documented by a nurse or medical director.
Perform non-medical research related to establishing, maintaining, and closing open cases.
Answer telephone calls from providers and members, take accurate messages, support electronic transmission review and referrals, and use internal tools to determine next steps based on clinical requirements and plan guidelines.
Maintain accurate and complete documentation that meets risk management, regulatory, and accreditation requirements.
Communicate internally and externally to enhance the effectiveness of medical management services, including with health care providers and team members.
Assist in obtaining discharge dates and make appropriate referrals to the clinical team for additional follow-up as needed.
Work independently on occasion, using good judgment and critical thinking while following department guidelines, policies, and procedures.
Adapt with urgency and flexibility to a rapidly changing environment while meeting quality and quantity performance standards.