Normal Working Hours: Monday through Friday 12:30pm-9:00pm EST.
There are occasional Saturday shifts and holiday shifts which are currently filled on a volunteer basis. If it becomes required, it will be approximately one Saturday per quarter and 1 holiday per year but is per the need of the department. The hours on Saturdays are typically 8:00am – 4:30pm EST.
There is no travel required with this position.
This Care Management Associate position is part of a high-volume call center and the employee will be answering between 40 to 60 calls per day (the team fields close to 10,000 calls per month on average).
The Care Management Associate is expected to be at their workstation logged into their computer and phone system and answering calls throughout the day. The Team’s leadership can monitor each employee’s engagement, volumes, and activity throughout the day.
Experience with a high-volume call center environment is a critical component with successful onboarding into the role.
Please only apply if you have worked in a call center for 6 months. Candidates without this experience will not be interviewed.
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:
- 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 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 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, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures. (*)
- 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.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
- Must have call center experience (minimum of 6 months experience). Please do not apply if you do not have 6 months of call center experience as you will not be interviewed.
- 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.
- 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
High School diploma or equivalent experience.
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.