Description
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.
Position Summary
The Care Management Associate (CMA) 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 include but not limited to the following:
- Evaluates 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 by the benefit plan.
- Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director
- Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
- Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate, utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Ensures communication, both internally and externally, to enhance the effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
- Assist in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
- Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.
- Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.
Required Qualifications
- 2 years’ experience as a medical assistant, office assistant or related 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 Excel and Microsoft Word.
Education
High School Diploma or equivalent GED
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$18.50 - $35.29
This 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.
