[Hiring] Care Management Associate @CVS Health

Role Description

The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services. We work closely with both case management and utilization management teams.

• Reviews eligibility and benefits, opens pre-certification cases, and either approves or sends to nursing staff for review.
• 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, and utilizing 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).
• Assists 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.

Qualifications

• 2 years’ experience as a medical assistant, office assistant or related experience.
• Minimum of 6 months of call center experience required.

Requirements

• 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.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.