CVS Health - Phoenix, AZ
posted about 2 months ago
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.