Inbound Outbound Queue Associate - OhioRISE - must reside in Ohio

CVS Health•Cleveland, OH

About The Position

The Inbound Outbound Queue Associate supports CVS Health’s OhioRISE program, which provides coordinated behavioral health services for children with serious or complex needs who are involved in, or at risk of involvement in, multiple child-serving systems. The role supports coordination of medical services through care team intake, screening, and implementation of care plans, with the goal of promoting effective use of healthcare services and quality outcomes. The associate conducts initial review and triage of care team tasks and ongoing management of Care Plan Review tasks. They support care plan development, implementation, and follow-up; communicate with providers, internal teams, and other healthcare team members; and maintain accurate, timely member records and program documentation. The role also includes non-medical research such as eligibility, coordination of benefits, and benefits verification, as well as administrative work and member transitions. The position requires compliance with applicable policies, procedures, regulatory and accreditation standards, and confidentiality requirements. The associate must reside in Ohio.

Requirements

Must reside in Ohio.
Effective communication and organizational skills, with 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.
Ability to work independently, meet deliverables and deadlines, and demonstrate an outgoing, enthusiastic, and caring presence.
Computer experience, including Microsoft Word, Outlook, and Excel, and data entry and documentation in member records.
Strong verbal and written communication skills.
High school diploma, G.E.D., or equivalent.

Nice To Haves

Two or more years of experience in a healthcare field, such as a medical office or hospital setting.
Familiarity with basic behavioral medical terminology and concepts used in care management.

Responsibilities

Conduct initial review and triage of care team tasks and manage Care Plan Review tasks.
Support the development, implementation, and follow-up of care plans.
Support coordination of medical services, including care team intake and screening.
Promote communication with providers, internal teams, and other healthcare team members to support medical management services.
Enter and maintain member records in the electronic health record system.
Document member calls and complete required actions, progress notes, letters, reports, and other program documentation accurately and promptly.
Conduct non-medical research, including eligibility, coordination of benefits, and benefits verification.
Communicate with Aetna internal teams when processing transitions for members active in the program.
Perform other administrative responsibilities as needed.
Protect confidential member information and follow company policies, procedures, and applicable regulatory and accreditation requirements.