[Remote] Care Manager Associate at CVS Health

Virginia, Minnesota, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

1-3 years of experience in General Business or Maximizing Work Practices experience
Basic knowledge of Benefits Management
Basic knowledge of Interacting with Medical Professionals
Basic knowledge of Service/Handling Service Challenges
Minimum of 1-3+ years experience as a medical assistant, office assistant, or related healthcare/medical role
Strong customer service skills to coordinate service delivery including attention to members and providers, sensitivity to issues, proactive identification
1-3 years of end user experience in Microsoft Outlook, Excel, Word (preferred)
Basic knowledge of Technology/Leveraging Technology (preferred)
Basic knowledge of Service/Working Across Boundaries (preferred)
Advanced knowledge of Service/Providing Solutions to Constituent Needs (preferred)

Responsibilities

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, Disease Management, Mixed Services, and other Specialty Programs
Utilizes eTUMS and other Aetna systems to build, research and enter member information, as needed
Supports 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 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

Skills

Key technologies and capabilities for this role

Care ManagementPatient TriageMedical ScreeningCare CoordinationUtilization ReviewCase ManagementDisease ManagementeTUMSHealthcare ServicesBenefit Plan Coordination

Questions & Answers

Common questions about this position

What are the main responsibilities of the Care Manager Associate role?

The role involves initial review and triage of Care Team tasks, screening patients using intervention tools, monitoring cases, identifying referrals to specialty programs, supporting care plan development, and coordinating health care services.

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 this position?

This information is not specified in the job description.

What systems or tools will I use in this role?

The role requires utilizing eTUMS and other Aetna systems to build, research, and enter member information.

What compliance standards must be followed in this role?

The position requires adherence to Compliance with PM Policies and Regulatory Standards, maintaining accurate documentation that meets risk management, regulatory, and accreditation requirements, and protecting member confidentiality.

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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