Care Manager Associate

CVS Health•Work At Home-Virginia, VA

3d•$19 - $35

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Care Management Associate (CMA) role supports comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.

Requirements

Minimum of 1-3+ years of experience in customer service, healthcare support, medical office, call center, care coordination, or another member-facing role.
Demonstrated ability to deliver exceptional service to members, patients, customers, or providers by actively listening, assessing needs, and providing timely, accurate solutions.
Experience managing member inquiries, resolving service-related issues, and coordinating with internal and external partners to achieve positive outcomes.
Strong interpersonal, communication, and problem-solving skills with a commitment to member satisfaction and service excellence.
Ability to navigate sensitive situations with empathy, professionalism, and a member-first approach.
Proficiency with Microsoft Outlook, Word, Excel, and other technology tools used to support member communications, documentation, case tracking, and issue resolution.

Nice To Haves

Experience supporting health plan members, patients, providers, or customers in a healthcare, insurance, or service-focused environment.
Demonstrated ability to collaborate across departments and provider networks to resolve complex member or customer issues.
Experience identifying opportunities to improve service delivery and enhance the overall member experience.
Ability to manage multiple priorities in a fast-paced environment while maintaining a high level of customer service.
Knowledge of healthcare benefits, insurance processes, medical terminology, or provider office operations.
Experience using technology and case management systems to document interactions, track issues, and support service resolution.

Responsibilities

Responsible for initial review and triage of Care Team tasks.
Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.
Monitors non-targeted cases for entry of appropriate discharge date and disposition.
Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Utilizes eTUMS and other Aetna systems to build, research and enter member information, as needed.
Support the Development and Implementation of Care Plans.
Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively)
Performs non-medical research pertinent to the establishment, maintenance and closure of open cases
Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
May assist in the research and resolution of claims payment issues.
Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.