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Phoenix, Arizona, United States
Remote only
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:
Must be within an hour of New Albany, Ohio, Phoenix, AZ, High Point, NC.
Training is 4 weeks, then 8 weeks with a preceptor.
8 hour shifts
Start Times Available:
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.
The Care Management Associate 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.
The Care Management Associate position duties include (not all encompassing):
-Responsible for initial review and triage of Care Team tasks.
-Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools.
-Utilizes Aetna systems to build, research and enter member information, as needed.
-Supports 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 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.
Required Qualifications
Preferred Qualifications
Education
High School diploma, or equivalent GED
Requisition Job Description
Primary Job Duties & Responsibilities
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.
Education
High school diploma or 5+ years equivalent experience.
Prior Relevant Work Experience
5+ years
Essential Qualifications
Adept at problem solving and decision making skills
Job Description
Work from Home Requirements:
• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own
workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements:
• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications
simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and
virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or
similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when
unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when
frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $35.29This 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 our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.