Case Manager Associate

CVS Health•Work At Home-Virginia, VA

1d•$19 - $35•Remote

About The Position

The Care Management Associate (CMA) supports the coordination of medical services, including Care Team intake, screening, and implementation of care plans to promote effective use of healthcare services and support the quality and effectiveness of Healthcare Services. The role performs initial triage of Care Team tasks, screens patients for needed services, coordinates referrals and service delivery, and escalates outlier cases and program triggers to appropriate clinical staff. It also supports care plans and case administration, communicates with providers and care team members, documents case information, and protects member confidentiality. The position is full-time, with 40 anticipated weekly hours, and is work-from-home subject to specified internet, workspace, security, and location requirements. CVS Health provides work equipment; employees provide their own desk or other workspace furniture.

Requirements

At least 1–3+ years of experience as a medical assistant, office assistant, or in a related healthcare or medical role.
Strong customer service skills, including attention to members and providers, sensitivity to issues, and proactive identification and resolution of issues to promote positive member outcomes.
1–3 years of end-user experience with Microsoft Outlook, Word, and Excel.
Have or be able to obtain a direct, hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
Maintain a quiet, secure, private, tidy, organized, and distraction-free designated home workspace that complies with CVS Health and HIPAA guidelines and allows uninterrupted work.
Work from home within the state and city where the employee has confirmed they currently live.
Provide personal workspace furniture, such as a desk or standing desk, and meet the work-from-home requirements, including required internet speeds.
Be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
Communicate using digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
Use Microsoft Office 365 applications or similar tools such as Google Workspace.
Access secure systems such as VPNs and EHR portals; secure the computer when unattended, manage strong passwords, and recognize suspicious emails or links.
Resolve common technical issues independently and contact IT for issues that cannot be resolved.
Be open to learning new skills as the workplace environment evolves.
High school diploma, GED, or equivalent experience.

Nice To Haves

Basic knowledge of technology and leveraging technology.
Basic knowledge of service and working across boundaries.
Advanced knowledge of service and providing solutions to constituent needs.

Responsibilities

Review and triage Care Team tasks.
Identify the principal reason for admission, facility, and member product to select appropriate intervention assessment tools.
Screen patients using targeted intervention rules and processes, identify needed medical services, make referrals to medical services staff, and coordinate services according to the benefit plan.
Monitor non-targeted cases to ensure appropriate discharge dates and dispositions are entered.
Identify outlier cases, such as length-of-stay cases, and refer them to clinical staff.
Identify triggers for referral to Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Use eTUMS and other Aetna systems to build, research, and enter member information as needed.
Support the development and implementation of care plans.
Coordinate and arrange healthcare service delivery under the direction of a nurse or medical director, identifying appropriate settings and opportunities to use participating providers and services.
Promote internal and external communication with healthcare providers and healthcare team members to support effective medical management services.
Conduct non-medical research related to establishing, maintaining, and closing open cases.
Support team members by answering calls, taking messages, researching information, and helping solve problems.
Comply with PM policies and regulatory standards.
Maintain accurate and complete documentation that meets risk management, regulatory, and accreditation requirements.
Protect confidential member information and follow company confidentiality policies.
May assist with researching and resolving claims payment issues.
Support hospital care, case management, and quality management processes in compliance with applicable laws, regulations, URAQ and/or NCQA standards, and CMSA standards where applicable, as well as company policies and procedures.