Case Manager Associate

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

POSITION SUMMARY
The Care Management Associate (CMA) role 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.

Fundamental Components of the Care Management Associate role include, but are not limited to:

· 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 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, while adhering to company policy and procedures.

Required Qualifications

• Minimum of 1-3+ years experience as a medical assistant, office assistant, or related healthcare/medical role required.
• Strong customer service skills to coordinate service delivery including attention to members and providers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• 1-3 years of end user experience with Microsoft Outlook, Word, and Excel

Work from Home Requirements:

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
• a minimum download speed of 25 mbs download and 3 mbs uploads. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
• Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own
• workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications
• simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and
• virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or
• similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when
• unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when
• frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Preferred Qualifications

• Basic Knowledge of Technology/Leveraging Technology
• Basic Knowledge Service/Working Across Boundaries

Advanced Knowledge of Service/Providing Solutions to Constituent Needs

Education

• The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.