[Remote] Care Management Associate at CVS Health

Texas Twp, Michigan, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

2 years’ experience as a medical assistant, office assistant or related experience
Minimum of 6 months of call center experience required
High School Diploma or equivalent GED

Responsibilities

Supports comprehensive coordination of medical services that include intake and outgoing calls for medical services
Works closely with both case management team and utilization management team
Reviews eligibility and benefits and opens pre-certification cases and either approves or sends to nursing staff for review
Evaluates 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 by the benefit plan
Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director
Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases
Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively)
Assists in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed
Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures
Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work

Skills

Key technologies and capabilities for this role

Care ManagementCase ManagementUtilization ManagementEligibility ReviewBenefits VerificationPre-certificationPatient CoordinationMedical ReferralsTelephone SupportDocumentationRegulatory ComplianceHealthcare Communication

Questions & Answers

Common questions about this position

What experience is required for the Care Management Associate position?

The role requires 2 years of experience as a medical assistant, office assistant, or related experience, plus a minimum of 6 months of call center experience.

What are the preferred qualifications for this role?

Preferred qualifications include effective communication, telephonic and organization skills, familiarity with basic medical terminology and concepts used in care management, and strong customer service skills.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What is the salary or compensation for the Care Management Associate role?

This information is not specified in the job description.

What skills make a strong candidate for this position?

Strong candidates will have the required experience in medical or office assistance and call centers, plus preferred skills like effective communication, organization, familiarity with medical terminology, and strong customer service, along with critical thinking and the ability to work independently.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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