Work At Home
Category: Customer Care
Remote
Description
Bring your heart to CVS Health. Every one of us at CVS Health 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 what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.
Supports comprehensive coordination of medical services including Care Team intake, screening, and supporting the implementation of care plans to promote effective utilization of healthcare services. The position promotes/ supports quality effectiveness of Healthcare Services.
- Adheres to compliance with policies and procedure/regulatory standards.Â
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.Â
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.  Â
- Responsible for initial review and triage of care team tasks and ongoing management of Care Plan Review tasks.
- Supports the development, implementation, and follow-up of care plans.
- Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., providers, and health care team members respectively).
- Enter and maintain member records in electronic health record system, compile reports and complete other program documentation in a timely manner (e.g., progress notes, letters), and other administrative responsibilities as needed.
- Completes documentation in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.Â
- Provides non-medical research including eligibility verification, COB and benefits verification.
- Communicate with Aetna internal teams when processing transitions for members active in this program.
Required Qualifications
- Effective communication and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm. Â
- 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, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).Â
- Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.Â
- Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic, and caring presence. Â
- Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records.
- Strong organizational skills, including effective verbal and written communication skills. Â
Preferred Qualifications
- 2+ years experience in healthcare field (i.e., experienced in medical office, hospital setting) preferred. Â
- Familiarity with basic behavioral medical terminology and concepts used in care management preferred.Â
Education
- High School diploma, G.E.D. or equivalent.Â
Pay Range
The typical pay range for this role is:
$17.00 - $25.65
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.Â
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. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS 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. Â
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 11/19/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
