Remote
Description
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
As a Care Management Associate, you will play a critical role in supporting our clinical partners and ensuring seamless coordination of medical management services. This position focuses on the initial review and triage of Medical Inpatient tasks, helping to maintain accuracy and efficiency in patient care processes.
Schedule:
- 6-8 Week Training will be Monday- Friday (8am-5pm) Saturday and Sunday 10-hour shifts with a start time of 8:30am in your time zone.
- All shifts will require Saturdays and Sundays, then the other 2 days can be chosen after the hire date.
Key Responsibilities:
A Care Management Associate will conduct initial reviews and triage inpatient medical tasks to ensure timely and accurate case routing. Verify essential admission details, including the principal reason for admission, facility information, and member product, to correctly update and forward cases for clinical review. Monitor cases for appropriate discharge dates and dispositions, maintaining data integrity throughout the process. Additionally, they will be responsible for identifying and escalating outlier cases, such as extended lengths of stay, to clinical staff for further evaluation, and recognize triggers for referral into Aetna’s Case Management programs to support continuity of care. Other responsibilities also include utilizing MedCompass and other Aetna systems to research, build, and maintain accurate member information, promoting effective communication internally and externally to enhance collaboration among healthcare providers and team members. Perform non-medical research to support case establishment, maintenance, and closure, provide administrative and operational support to team members as needed, and make outbound calls to providers daily to gather or verify information. (Note: This is not an inbound call center role.)
Required Qualifications:
- 2-4 years Customer service experience.
- Demonstrates ability to meet daily metrics a with speed, accuracy and a positive attitude and strong written and oral communication skills.
- Strong attention to detail and organizational skills.
- Ability to work independently while collaborating effectively with clinical teams.
- Excellent communication skills for interacting with providers and internal stakeholders.
- Proficiency in navigating healthcare systems and tools (MedCompass experience preferred).
- Commitment to delivering high-quality service and supporting patient care outcomes.
Preferred Qualifications
- Researching information and assisting in solving problems
- Knowledge of Medical Terminology
- 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 law and regulation, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.
- Demonstrated ability to handle multiple assignments competently, accurately, and efficiently.
- 2-4 years of experience healthcare field, medical/health setting, medical billing and coding.
Education
- High School Diploma or G.E.D.
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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
