Care Management Analyst - Work at Home

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. Care Management Associate - entry level Location: Work at home Schedule: Mon-Fri 8-5 EST 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 qual‐ity 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 ser‐vices 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. 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 effective‐ness 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.

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.

Medical office experience Medicaid Experience Customer Service Care Coordination Technical Skills 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 40 Time Type Full time Pay Range The typical pay range for this role is: $18.50 - $35.29 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