Care Management Associate - OhioRISE - Must reside in Ohio at CVS Health

Cincinnati, Ohio, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must reside in Ohio
Possess reliable transportation and willingness for some in-state travel (5-10%) for meetings, community engagement, and training
Ability to work full-time, predominately remote telework position, Monday – Friday, 8am-5pm

Responsibilities

Responsible for initial review and triage of members
Manages population health member enrollment for child and family welfare
Manages a low tier member caseload
Develops wellness plans, provides community resources, reviews gaps in care, administers health questionnaires, and addresses other targeted child welfare goals applicable to population health
Completes outbound calls to identify and engage appropriate community resources
Screens members using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate required services in accordance with the benefit plan
Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs
Utilizes Aetna systems to build, research, and enter member information as needed
Supports the development and implementation of wellness 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., with health care providers and health care team members)
Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases
Provides support services to team members by answering telephone calls, researching information, and assisting in solving problems
Adheres to compliance with 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 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

Skills

Care Coordination

Member Enrollment

Triage

Wellness Plans

Community Resources

Gaps in Care Analysis

Health Questionnaires

Outbound Calls

Population Health Management

Child Welfare

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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