Care Management Associate - Engagement Hub

CVS Health

1d•Remote

About The Position

This remote position is for Aetna’s Medicaid Care Management Engagement Outreach Hub, a new initiative focused on enhancing Medicaid member interaction and maximizing touchpoints to address member needs and foster behavioral change. The team consists of dedicated healthcare professionals who engage with members using passion, caring, and behavioral interviewing techniques, aiming to exceed Medicaid healthcare service delivery standards. The role emphasizes the Hub’s efficiency and productivity, with Care Management Associates interacting telephonically with members. This comprehensive care coordination, supported by the Hub team, demonstrates innovative healthcare navigation and motivational health plan customer support. The Engagement Outreach Hub Care Management Associate is responsible for supporting comprehensive coordination of healthcare services through telephonic outreach and enrollment of eligible members. Associates act as a blend of salesperson, healthcare navigator, and health plan customer support representative, facilitating case assignment and connecting identified members to care managers via warm transfers. Successful enrollment into care management supports the implementation of care plans, promoting effective utilization of healthcare services and quality effectiveness.

Requirements

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
High School diploma or equivalent GED

Nice To Haves

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
Bilingual (Spanish)
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

Interact and engage telephonically with members
Support comprehensive coordination of healthcare services through telephonic outreach to and enrollment of eligible members
Conduct direct member outreach and engagement
Facilitate case assignment
Connect identified members to care managers immediately through a warm transfer
Support the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness
Provide support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems
Adhere to Compliance with policies and procedure/regulatory standards
Maintain accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
Protect the confidentiality of member information and adhere to company policies regarding confidentiality