Care Management Associate - Work From Home

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 Supporting comprehensive coordination of National Medical Excellence Program handling inbound calls from the phone queue. Additional responsibilities to include but not limited to the following: - Performs intake of calls from providers or members - Utilizes Aetna Systems such as MedCompass, HRP, ASD, CEC, and ATV and other Aetna systems to build, research and enter member information in applicable system. - Performs non-medical research including eligibility verification, COB, and benefits verification. - Maintains accurate and complete documentation of required information and meets risk management, regulatory and accreditation requirements. - Performs intake of calls from members or providers regarding services via telephone, fax, EDI. - These duties may include but are not limited to processing referrals, making outreach calls, entering data. - Collaborates with the clinical team, medical directors, claims and contacting staff. - Communicates with transplant financial coordinator at the transplant center. - Initiates authorizations regarding kidney transplants in accordance with unit processes. - Communicates with the member or provider regarding transplant services. - Build shell cases for transplant, cellular therapy, and gene therapy services request and task to nurse review. • Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., Providers, family, and health care team members respectively) • Protects the confidentiality of member information and adheres to company policies regarding confidentiality. - Supports the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards, where applicable, while adhering to company policy and procedures. - Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program. - Sedentary work involving significant periods of sitting, talking, hearing, and keying. - Work requires visual acuity to perform close inspection of written and computer-generated documents - Other duties as assigned. Required Qualifications - 2+ years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience. - Computer skills, including Microsoft Office Suite (Specifically Excel) - Ability to communicate with diverse populations - Ability to collaborate with and work in a team environment - Flexibility and ability to work independently Preferred Qualifications -1+ years prior Insurance experience, preferably in a Call Center. -Telephonic Customer Service experience -1+ years of prior authorization experience Education -High School Diploma or equivalent GED Required -Associate Degree Preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $35.29 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.    Our people fuel o