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Care Management Associate ID-6520

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.

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Position Summary
Schedule: 8 hours between 8:00 am - 5:30 pm in designated time zone.

4- 10 hour shifts, Saturday and Sunday included

Applicant does not need to reside in Texas

 

As a Care Management Associate you will be supporting 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. Responsible for initial review and triage of Care Team tasks. Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools. Screens 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 Med Compass and other 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.
Required Qualifications

  • 2-4 years of experience healthcare field, medical/health setting, medical billing and coding
  • Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically
  • Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude and strong written and oral communication skills.


Preferred Qualifications

  • 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.
  • Demonstrated ability to handle multiple assignments competently, accurately, and efficiently. Customer service experience, Knowledge of Medical Terminology


Education

  • High School Diploma or G.E.D
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