Care Management Associate Job Listing at CVS Health in Hartford, CT (Job ID R0201668)

Description

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.   Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary* This group provides support services, such as Document Imaging, DataEntry, Administrative Support (limited) and Mail. They make sure these behind-the scenes business activities run smoothly on a daily basis.  Provide the office support needed to ensure that business objectives are met.  Will also onboard clinical staff (MDs & RN) for job readiness.   *Responsibilities* * Triages and troubleshoots incoming calls for proper business unit assignment (NACMST, customer service, member services, appeals, etc) Liaison for external providers to advocate for members.  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.  Ability to effectively participate in a multi-disciplinary team including internal and external participants * Coordinates and arranges for health care service delivery under the direction of medical director (nurse as applicable) .  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. Researches case specific turnaround timeframes to properly determine applicable deadlines for MDs.   Provides support services to team members. * Supports the administration of the hospital care, case management and quality management processes in compliance with various state laws and regulations, CMS, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures. * 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. *  Identifies applicable platform for P2P (Peer to Peer) incoming calls, triages cases utilizing ATV and MedCompass and other Aetna systems to build, research and enter member information to support the development of MD tasks including pertinent details regarding MD call backs.  Triage calls for turnaround timeframes, notate applicable information as case requires.  * Identifies and performs referral of Medicare or Commercial appeals cases via the CATs system to the applicable territory, market, and MD.  Where applicable ascertain proper MD board certification and MD licensure prior to assignment based upon AOC grid. * Coordinates other assigned duties to support MD's and nurses including but not limited to assisting with proper PO allocations and submissions based upon vendor requirements. * Coordinates (as needed) onboarding functions and other administrative duties as needed to support the MDs and nursing staff *Required Qualifications* Minimum of 6 months of call center experience required. *Preferred Qualifications* * Effective communication, telephonic and organization skills. * Familiarity with basic medical terminology and concepts used in care management. * 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. * Computer literacy to navigate through Internal/external computer systems, including Excel and Microsoft Word. *Education* High School Diploma or equivalent experience *Pay Range* The typical pay range for this role is: $18.50 - $37.02This 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](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 04/16/2024