Care Management Associate- OhioRISE - must reside in Ohio

CVS Health • Mentor, KY

4d • $19 - $35 • Remote

About The Position

The Care Management Associate (CMA) manages enrollment for the Children’s Specialty program, including members in foster care and child and family welfare populations, as well as other programs serving children with special healthcare needs. The position carries a low-tier caseload and supports coordination of medical services, including Care Team intake, screening, and implementation of Wellness Plans to promote effective use of healthcare services.

This full-time remote telework role is limited to candidates who reside in Ohio. The schedule is Monday through Friday, 8 a.m. to 5 p.m., during standard business hours. A flexible schedule may be available after six months of service, subject to demonstrated performance and attendance and business needs. In-state travel of 5–10% may be required for meetings, community engagement, and training; reliable transportation and willingness to travel are required, and mileage is reimbursed according to company policy.

The position works under the direction of a nurse or medical director to coordinate and arrange healthcare delivery in the appropriate setting and identify opportunities to use participating providers and services. The CMA collaborates with members, community resources, healthcare providers, and multidisciplinary teams; completes outreach and documentation; and follows company policies and applicable compliance, regulatory, risk-management, and accreditation requirements. The role requires passing the CANS certification exam within the first three months of employment to administer CANS with child and family teams.

Requirements

• Must reside in Ohio.
• Two to four years of experience in healthcare or working with foster care, child and family welfare populations, such as in a medical office, hospital, or community health case worker setting.
• Effective communication, telephone, and organizational skills, including the ability to manage multiple priorities and adapt to change.
• Strong customer service skills, including attention to customers, sensitivity to issues, and proactive identification and resolution of issues.
• At least two years of demonstrated proficiency with personal computers, keyboards, multiple-system navigation, and Microsoft Office applications such as Teams, Outlook, Word, and Excel.
• Must have reliable transportation and be willing to travel in-state 5–10% for meetings, community engagement, and training.
• Must pass the CANS certification exam within the first three months of employment to administer CANS with child and family teams.
• High school diploma or GED.

Nice To Haves

• Motivational interviewing skills.
• Call center experience.
• Managed care experience.

Responsibilities

• Conduct initial member review and triage.
• Manage population health enrollment for child and family welfare members.
• Manage a low-tier member caseload.
• Develop Wellness Plans, provide community resources, review gaps in care, administer health questionnaires, and address targeted child welfare population health goals.
• Make outbound calls to identify and engage appropriate community resources and promote active member connection through persistent outreach.
• Screen members using targeted intervention rules and processes, identify needed medical services, make appropriate referrals, and coordinate services in accordance with the benefit plan.
• Identify triggers for referral to Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Use Aetna systems to build, research, and enter member information as needed.
• Support development and implementation of Wellness Plans and coordinate healthcare delivery under the direction of a nurse or medical director.
• Promote effective communication with healthcare providers and other healthcare team members.
• Conduct non-medical research related to establishing, maintaining, and closing cases.
• Support team members by answering telephone calls, researching information, and helping resolve problems.
• Comply with company policies and regulatory standards and maintain accurate, complete documentation that meets risk-management, regulatory, and accreditation requirements.
• Protect confidential member information and follow company confidentiality policies.
• Assist with researching and resolving claims payment issues when needed.
• Support hospital care, case management, and quality management processes in accordance with applicable laws, regulations, URAC and/or NCQA standards, CMSA standards where applicable, and company procedures.
• Complete detailed documentation of each member call in the electronic record and ensure required actions are completed efficiently and compliantly.
• Meet daily metrics with speed and accuracy while managing multiple priorities and adapting to change.
• Work independently to meet deliverables and deadlines and participate effectively in multidisciplinary teams with internal and external participants.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources supporting physical, emotional, and financial well-being, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED