Care Manager Associate

CVS Health • Home, PA

28d • $19 - $35

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe 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.Fundamental Components of the Care Management Associate role include, but are not limited to: 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 casesProvides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.Adheres to Compliance with PM Policies and Regulatory Standards.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.

Requirements

• 1-3 years of experience in General Business or Maximizing Work Practices experience
• Basic knowledge of Benefits Management
• Basic knowledge of Interacting with Medical Professionals
• Basic knowledge of Service/Handling Service Challenges
• Minimum of 1-3+ years experience as a medical assistant, office assistant, or related healthcare/medical role required.
• Strong customer service skills to coordinate service delivery including attention to members and providers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• High School diploma, G.E.D. or equivalent experience.

Nice To Haves

• Basic knowledge of Technology/Leveraging Technology
• Basic knowledge of Service/Working Across Boundaries
• Advanced knowledge of Service/Providing Solutions to Constituent Needs
• 1-3 years of end user experience in Microsoft Outlook, Excel, Word

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.
• Adheres to Compliance with PM Policies and Regulatory Standards.
• 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.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees