Care Management Associate

Company: CVS Pharmacy
Location: Irving
Posted on: August 3, 2022

Job Description:

Job DescriptionResponsible 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 process 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 anddisposition.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 eTUMS 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 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.Required QualificationsExperience in call center or customer service environment. 2 - 4 years' experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding), with familiarity with medical terminology. Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm. Demonstrates ability to meet daily metrics with speed, accuracy and a positive attitude and strong written and oral communication skills. 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, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures). Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic and caring presence telephonically. Ability to effectively participate in a multi-disciplinary team including internal and external participants.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsExperience in call center or customer service environment. 2 - 4 years' experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding), with familiarity with medical terminology.EducationAssociate's degree or equivalent work experience.Business OverviewBring your heart to CVS HealthEvery 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.

Keywords: CVS Pharmacy, Irving , Care Management Associate, Executive , Irving, Texas