Care Management Associate

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Position Summary

The Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of eligible members.  Our Care Management Associates (CMAs) demonstrate a highly energetic blend of salesperson, healthcare navigator and health plan customer support representative.  The Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers. By successfully enrolling members into care management, the CMA further supports the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness. 

Position Responsibilities:

• Takes the lead in member outreach to screen members for risk stratification and ensure compliance with outreach and contact requirements.
• Identifies triggers for referral into Aetna's care management, chronic condition disease management, mixed services, and other care management and/or specialty programs.
• Screens members 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.
• Receives warm transfers from IVR outreach, member services, social impact team and screens members using targeted intervention rules and processes to identify needed services and make appropriate referrals to clinical services staff.
• Promotes communication, both internally and externally to enhance effectiveness of care management services (e.g. providers, and health care team members respectively).
• Coordinates and arranges for health care service delivery under the direction of the care manager or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the member to utilize participating providers and services.
• Provides support services to care coordination team members by answering telephone calls, taking messages, researching information and assisting in problem solving.
• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.
• Provides administrative support to additional care coordination resources (value adds) program to include confirming member eligibility and processing requests.
• Adheres to compliance with policies and procedure/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.
• Demonstrates ability to meet daily metrics with speed, accuracy, and a positive attitude.
• Completes documentation of member calls in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.

Reports to:  Manager, Clinical Health Services, IL

Required Qualifications

• Must live near Downers Grove, IL
• Up to 10% travel – meetings in office once/quarter + additional trainings
• 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
• 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.
• Strong organizational skills, including effective verbal and written communication skills.

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​Preferred Qualifications

• Familiarity with basic medical terminology and concepts used in care management preferred.
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records preferred.  
• Bilingual (Spanish) preferred.
• 2 – 4 years’ experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding) preferred 

Education

• High School diploma, G.E.D. or equivalent experience

Pay Range

The typical pay range for this role is:

$18.50 – $37.02

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 06/18/2024