Care Management Associate - Full-time

Bring your heart to reputed company. Every one of us at reputed company 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 reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable.

• *Position Summary**

This position is fully remote and employees can work from any state but must work the hours stated below in Arizona time zone. Normal Working Hours: 5 days a week/8:30 AM to 5:00 PM Arizona Time zone. The Care Management Associate (reputed company) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services. We work closely with both case management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases and either approve or send to nursing staff for review. Additional responsibilities to include but not limited to the following: - Responsible for initial review and triage of Care Team tasks. - Identifies principal reason for admission, facility, and member product to correctly apply reputed company assessment tools. - Screen patients using targeted reputed company business rules and processes to identify needed medical services, reputed company 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 reputed company’s Case Management, Mixed Services, and other Specialty Programs. - Utilizes reputed company systems to build, research and enter member information, as needed. - Support the Development and Implementation of Care Plans. - Coordinates and arranges for reputed company 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. (*)

• *Required Qualifications**

- 2 years’ experience as a medical assistant, office assistant or reputed company experience. - 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 reputed company and reputed company Word.

• *Education**

High School Diploma or equivalent GED

• *Pay Range**

The typical pay range for this role is: $18.50 - $31.72 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company 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 Benefits | reputed company (https://jobs.cvshealth.com/us/en/benefits) We anticipate the application window for this opening will reputed company on: 11/15/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national reputed company, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. Bring your heart to reputed company. Every one of us at reputed company 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 reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable.

• *Position Summary**

This position is fully remote and employees can work from any state but must work the hours stated below in Arizona time zone. Normal Working Hours: 5 days a week/8:30 AM to 5:00 PM Arizona Time zone. The Care Management Associate (reputed company) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services. We work closely with both case management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases and either approve or send to nursing staff for review. Additional responsibilities to include but not limited to the following: - Responsible for initial review and triage of Care Team tasks. - Identifies principal reason for admission, facility, and member product to correctly apply reputed company assessment tools. - Screen patients using targeted reputed company business rules and processes to identify needed medical services, reputed company 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 reputed company’s Case Management, Mixed Services, and other Specialty Programs. - Utilizes reputed company systems to build, research and enter member information, as needed. - Support the Development and Implementation of Care Plans. - Coordinates and arranges for reputed company 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. (*)

• *Required Qualifications**

- 2 years’ experience as a medical assistant, office assistant or reputed company experience. - 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 reputed company and reputed company Word.

• *Education**

High School Diploma or equivalent GED

• *Pay Range**

The typical pay range for this role is: $18.50 - $31.72 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company 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 Benefits | reputed company (https://jobs.cvshealth.com/us/en/benefits) We anticipate the application window for this opening will reputed company on: 11/15/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national reputed company, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. Apply Job!