Care Management Associate
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Job Description
Care Management Associate coordinating National Medical Excellence and transplant services for CVS Health members. Handling calls, authorizations, eligibility checks, and clinical-team coordination remotely.
Responsibilities:
- Support comprehensive coordination of the National Medical Excellence Program by handling inbound calls from the phone queue
- Perform intake of calls from providers or members
- Use Aetna systems such as MedCompass, HRP, ASD, CEC, ATV, and other systems to build, research, and enter member information
- Perform non-medical research, including eligibility verification, COB, and benefits verification
- Maintain accurate and complete documentation and meet risk management, regulatory, and accreditation requirements
- Process referrals, make outreach calls, and enter data
- Collaborate with the clinical team, medical directors, claims, and contacting staff
- Communicate with transplant financial coordinators at transplant centers
- Initiate authorizations for kidney transplants in accordance with unit processes
- Communicate with members or providers regarding transplant services
- Build shell cases for transplant, cellular therapy, and gene therapy service requests and task them for nurse review
- Promote internal and external communication to enhance medical management services
- Protect member confidentiality and follow company confidentiality policies
- Support administration of the precertification process in compliance with applicable laws, regulations, NCQA standards, and company policies
- Communicate with Aetna nurses and medical directors when processing transactions for members active in the program
- Perform sedentary work involving significant periods of sitting, talking, hearing, and keying
- Perform other duties as assigned
Requirements:
- 2+ years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
- Computer skills, including Microsoft Office Suite, specifically Excel
- Ability to communicate with diverse populations
- Ability to collaborate with and work in a team environment
- Flexibility and ability to work independently
- High School Diploma or equivalent GED Required
- 1+ years prior insurance experience, preferably in a Call Center
- Telephonic Customer Service experience
- 1+ years of prior authorization experience
- Associate Degree Preferred
Benefits:
- CVS Health bonus, commission or short-term incentive program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
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