CVS Health
Care Management Associate - Weekend Position
CVS Health, Columbus, Ohio, United States, 43224
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Care Management Associate - Weekend Position
role at
CVS Health .
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 As a Care Management Associate you will support comprehensive coordination of medical services including Care Team intake, screening, and implementation of care plans to promote effective utilization of health services. You will promote and support the quality effectiveness of healthcare services.
Position Responsibilities
Initial review and triage of Care Teams tasks.
Identify principal reason for admission, facility, and member product to correctly apply intervention assessment tools.
Screen 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 in accordance with the benefit plan.
Monitor non-targeted cases for entry of appropriate discharge date and disposition.
Identify and refer outlier cases (e.g., Length of Stay) to clinical staff. Identify triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Utilize Med Compass and Aetna systems to build, research and enter member information as needed.
Support development and implementation of Care Plans.
Coordinate and arrange health care service delivery under the direction of nurse or medical direction in the appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
Promote communication, both internally and externally, to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
Perform non-medical research pertinent to the establishment, maintenance and closure of open cases.
Provide support services to team members.
Assist in research and resolution of claims payment issues. Support administration of 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.
Hours of Operation: Training and work schedule will be between the hours of 8:00 AM-8:00 PM ET, training will be approximately 4 to 8 weeks. 8‑hour training shifts Monday‑Friday, 40 hours a week.
Position is for a Weekend Care Management Associate: 10‑hour days (4 days per week) with a schedule of 7:00‑5:30 PM in your respective time zone on Saturday and Sunday, along with two other days during the week (Monday‑Friday).
Weekend and Holiday hours will be required.
Required Qualifications
2‑4 years of experience within the healthcare field, medical/health setting, medical billing and coding.
Experience in a call center or customer service environment.
Ability to work independently, meeting deliverables and deadlines with a demonstration of an outgoing, enthusiastic and caring presence telephonically.
Demonstrated ability to meet daily metrics with speed, accuracy and a positive attitude, and strong written and oral communication skills.
Preferred Qualifications
Researching information and assisting in solving problems.
Adherence 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 confidentiality of member information and adheres to company policies regarding confidentiality.
Demonstrated ability to handle multiple assignments accurately and efficiently.
Knowledge of medical terminology.
Education
High School Diploma or G.E.D.
Pay Range The Typical Pay Range for This Role Is
$18.50 – $42.35 per hour.
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.
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.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Care Management Associate - Weekend Position
role at
CVS Health .
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 As a Care Management Associate you will support comprehensive coordination of medical services including Care Team intake, screening, and implementation of care plans to promote effective utilization of health services. You will promote and support the quality effectiveness of healthcare services.
Position Responsibilities
Initial review and triage of Care Teams tasks.
Identify principal reason for admission, facility, and member product to correctly apply intervention assessment tools.
Screen 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 in accordance with the benefit plan.
Monitor non-targeted cases for entry of appropriate discharge date and disposition.
Identify and refer outlier cases (e.g., Length of Stay) to clinical staff. Identify triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Utilize Med Compass and Aetna systems to build, research and enter member information as needed.
Support development and implementation of Care Plans.
Coordinate and arrange health care service delivery under the direction of nurse or medical direction in the appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
Promote communication, both internally and externally, to enhance effectiveness of medical management services (e.g., health care providers, and health care team members respectively).
Perform non-medical research pertinent to the establishment, maintenance and closure of open cases.
Provide support services to team members.
Assist in research and resolution of claims payment issues. Support administration of 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.
Hours of Operation: Training and work schedule will be between the hours of 8:00 AM-8:00 PM ET, training will be approximately 4 to 8 weeks. 8‑hour training shifts Monday‑Friday, 40 hours a week.
Position is for a Weekend Care Management Associate: 10‑hour days (4 days per week) with a schedule of 7:00‑5:30 PM in your respective time zone on Saturday and Sunday, along with two other days during the week (Monday‑Friday).
Weekend and Holiday hours will be required.
Required Qualifications
2‑4 years of experience within the healthcare field, medical/health setting, medical billing and coding.
Experience in a call center or customer service environment.
Ability to work independently, meeting deliverables and deadlines with a demonstration of an outgoing, enthusiastic and caring presence telephonically.
Demonstrated ability to meet daily metrics with speed, accuracy and a positive attitude, and strong written and oral communication skills.
Preferred Qualifications
Researching information and assisting in solving problems.
Adherence 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 confidentiality of member information and adheres to company policies regarding confidentiality.
Demonstrated ability to handle multiple assignments accurately and efficiently.
Knowledge of medical terminology.
Education
High School Diploma or G.E.D.
Pay Range The Typical Pay Range for This Role Is
$18.50 – $42.35 per hour.
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.
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.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr