HireMO

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

Training Schedule anytime between: 8:00 am - 7:00 pm EST (this will change once they are out of training) .

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, 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

- Experience in call center or customer service environment

- 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, a positive attitude, and strong written and oral communication skills.

- This role requires the ability to work efficiently across multiple systems simultaneously, including Microsoft Office 365 applications, clinical platforms, and health plan systems

- Technically proficient, with the ability to navigate computer systems and digital tools efficiently

- Ability to work independently while collaborating effectively with clinical teams.

- Excellent communication skills for interacting with providers and internal stakeholders.

- Commitment to delivering high-quality service and supporting patient care outcomes.

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.

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 upload. 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

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

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 s...

Apply Externally

Jobs

Care Management Associate

Summary

You Need a MO Jobs Account First

Jobs

Jobs

Care Management Associate

Summary

Do You Have a MO Jobs Account?

First, Let's Find Your MO Jobs Account

Create an Account to Apply

You Need a MO Jobs Account First

HireMO Terms of Use

1. Acceptance and Changes

2. A No-Cost Public Workforce Service

3. Eligibility, Youth, and Authority

4. Accounts and Security

5. Accuracy Attestation and Program Information

6. Job Seeker Terms

7. Employer Terms

8. Assessments and Matching

9. Artificial Intelligence Features

10. Public Records and Required Notices

11. User Content and Permissions

12. Acceptable Use

13. Intellectual Property and Government Marks

14. Other Users and Third-Party Services

15. Electronic Communications

16. Suspension, Termination, and Records

17. Disclaimers

18. Limitation of Liability and Sovereign Immunity

19. Employer Indemnification

20. Governing Law and General Terms

21. Contact, Accessibility, and Complaints