Care Management Associate

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About the role

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. Schedule:   • Schedule will be set; shifts will be based   off   a Central   time schedule. The phone que ue   is open from   7 am- 6 pm   Central   Time.   • Ideally, looking for someone to fill the   9 30am- 6 pm   Central   timeslot.      Position Summary     • The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services.    • We work closely with both case management and   utilization   management team s .   • The Care Management Associate will review eligibility and benefits ,   open pre-certification cases ,   and either approve or send to nursing staff for review.     Additional   responsibilities include but not limited to the following:     • Evaluates 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 by the benefit plan.   • Communicates health care service delivery as   required   based on outcomes/reviews noted by the nurse or medical director   • Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.   • Provides support services to team members by answering telephone calls from providers and members, taking   accurate   messages, supporting electronic transmission review and referrals as   appropriate ,   utilizes   internal tools to   determine   required steps to ensure proper review based on clinical requirements as well as established plan guidelines.   • Maintains   accurate   and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.   • Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team   members   respectively).   • Assist   in obtaining discharge dates and making   appropriate referrals   to   clinical   team for their engagement in   additional   follow up as needed.    • Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.   • Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.         Required Qualifications     • 2 years’ experience as a medical assistant, office   assistant   or related experience.   • Minimum of 6 months of call center experience   required .     Preferred Qualifications     • Effective communication,   telephonic   and organization skills.   • Familiarity with basic medical terminology and concepts used in care management.   • Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members.   • Computer literacy to navigate through Internal/external computer systems, including Excel and Microsoft Word.     Education     • High School Diploma or equivalent GED   Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $35.29

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