Care Management Associate, Service Operations

CVS Health•Work At Home-Illinois, IL

4d•$19 - $42

About The Position

Aetna’s Medicaid Care Management Engagement Outreach Hub is a new initiative focused on prioritizing interaction with Medicaid members, maximizing inbound and outbound touchpoints, addressing members’ needs, and supporting behavioral change. The Hub’s Care Management Associates engage members by telephone using caring, motivational, and behavioral interviewing techniques, with a focus on efficiency and productivity. The Care Management Associate supports coordination of healthcare services through telephonic outreach to eligible members and enrollment in care management. The role combines member outreach and engagement with healthcare navigation and health plan customer support. Associates facilitate case assignment and connect identified members with care managers through warm transfers. Successful enrollment supports implementation of care plans and effective use of healthcare services. The position also provides support to team members by answering telephone calls, taking messages, researching information, and helping solve problems. It requires compliance with policies, procedures, and regulatory standards; accurate and complete documentation; and protection of confidential member information.

Requirements

Demonstrated ability to meet daily metrics with speed, accuracy, and a positive attitude.
Effective communication, telephone, and organizational skills, including the ability to manage multiple priorities and adapt to change.
Strong customer service skills, including attentiveness, sensitivity to issues, proactive issue identification and resolution, and support for positive member outcomes.
Ability to complete detailed member-call documentation efficiently and meet compliance requirements.
Ability to work independently, meet deliverables and deadlines, and maintain an outgoing, enthusiastic, and caring presence by telephone.
Ability to participate effectively in a multidisciplinary team with internal and external participants.
High school diploma, GED, or equivalent.

Nice To Haves

Experience with computers, including Microsoft Word, Outlook, and Excel, and data entry and documentation in member records.
Four years of healthcare experience, such as in a medical office, hospital, or medical billing/coding setting.
Familiarity with basic medical terminology and concepts used in care management.
Flexibility to work occasional nights and weekends outside standard business hours, which can span 8:00 a.m. to 8:00 p.m.
Strong organizational skills and effective verbal and written communication skills.
Spanish bilingual ability.

Responsibilities

Conduct telephone outreach to eligible members and support their enrollment in care management.
Engage members, identify their needs, and connect identified members to care managers through warm transfers.
Facilitate case assignment and support implementation of care plans to promote effective utilization of healthcare services and quality outcomes.
Answer telephone calls, take messages, research information, and assist team members in solving problems.
Document each member call in the electronic record, completing required actions accurately and thoroughly.
Follow care management processes and comply with privacy, confidentiality, quality, regulatory, accreditation, and company requirements.
Protect the confidentiality of member information.