Care Management Associate

$38,480 - $73,403/Yr

CVS Health - Phoenix, AZ

Full-time - Entry Level

Phoenix, AZ

Health and Personal Care Retailers

About the position

The Care Management Associate at CVS Health plays a crucial role in the coordination of medical services, ensuring that patients receive the necessary care in a timely and efficient manner. This position involves comprehensive support for the Care Team, including intake processes, screening, and the implementation of care plans aimed at optimizing healthcare service utilization. The Care Management Associate is responsible for the initial review and triage of Care Team tasks, identifying the principal reasons for patient admissions, and applying appropriate intervention assessment tools to facilitate effective care delivery. In this role, the associate will screen patients using targeted intervention business rules to identify required medical services and make appropriate referrals to medical staff. They will also monitor non-targeted cases to ensure accurate discharge dates and dispositions are recorded. The associate will identify outlier cases, such as those with extended lengths of stay, and refer them to clinical staff for further action. Additionally, they will recognize triggers for referrals into various management programs, utilizing Aetna systems to manage member information effectively. The Care Management Associate will support the development and implementation of care plans, coordinating healthcare service delivery under the guidance of a nurse or medical director. This includes promoting communication among healthcare providers and team members to enhance the effectiveness of medical management services. The associate will also perform non-medical research related to case management and provide support services to team members, ensuring compliance with regulatory standards and maintaining accurate documentation of all required information. Protecting member confidentiality and adhering to company policies is paramount in this role, as is assisting in the resolution of claims payment issues when necessary.

Responsibilities

• 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.
• Screen 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 in accordance with the benefit plan.
• Monitors non-targeted cases for entry of appropriate discharge date and disposition.
• Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
• Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Utilizes Aetna systems to build, research and enter member information, as needed.
• Support the Development and Implementation of Care Plans.
• Coordinates and arranges for health care service delivery under the direction of nurse or medical director.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services.
• 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 PM 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.

Requirements

• Must have call center experience (minimum of 6 months experience)
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel
• Proficiency in typing for keying in information and navigating in multiple systems
• Requires long periods of sitting and telephone and computer work.

Nice-to-haves

• Data entry and documentation
• Medical terminology knowledge
• Strong telephonic communication skills
• Strong organizational skills with an ability to prioritize tasks to meet time-sensitive deadlines
• Effective verbal and written communications skills with both customers and teammates
• 2 years of experience in either customer service, telemarketing and/or sales

Benefits

• Full range of medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance plan
• Short-term and long-term disability benefits
• Numerous well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year