Care Management Associate
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Job Description
Care Management Associate coordinating medical services, referrals, and pre-certification cases for CVS Health members. Supporting case management and utilization management teams remotely from Texas.
Responsibilities:
- Support comprehensive coordination of medical services through intake and outgoing calls
- Work closely with case management and utilization management teams
- Review eligibility and benefits
- Open pre-certification cases and approve them or send them to nursing staff for review
- Evaluate patients using targeted intervention business rules and processes
- Identify needed medical services, make appropriate referrals and coordinate services according to the benefit plan
- Communicate health care service delivery based on nurse or medical director outcomes and reviews
- Perform non-medical research for establishing, maintaining and closing open cases
- Answer provider and member telephone calls and take accurate messages
- Support electronic transmission review and referrals as appropriate
- Use internal tools to determine required steps for review based on clinical requirements and plan guidelines
- Maintain accurate and complete documentation meeting risk management, regulatory and accreditation requirements
- Communicate internally and externally with health care providers and health care team members
- Obtain discharge dates and make appropriate referrals to the clinical team for follow-up
- Work independently using judgment and critical thinking while following department guidelines, policies and procedures
- Meet quality and quantity performance standards in a rapidly changing environment
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
- Effective communication, telephonic and organization skills
- Familiarity with basic medical terminology and concepts used in care management
- Strong customer service skills, including attention to customers, sensitivity to issues, proactive identification and resolution of issues
- Computer literacy to navigate internal and external computer systems, including Excel and Microsoft Word
Benefits:
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- CVS Health bonus, commission or short-term incentive program in addition to base pay
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