Care Mgt Associate

Job 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. Position Summary: Must be within an hour of New Albany, Ohio, Phoenix, AZ, High Point, NC. Training is 4 weeks, then 8 weeks with a preceptor. 8 hour shifts Start Times Available: Variable per location 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. The Care Management Associate 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. Promotes/supports quality effectiveness of Healthcare Services. The Care Management Associate position duties include (not all encompassing): -Responsible for initial review and triage of Care Team tasks. -Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools. -Utilizes Aetna systems to build, research and enter member information, as needed. -Supports the development and implementation of Care Plans. -Coordinates and arranges for health care service 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 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 of experience in either customer service, telemarketing and/or sales Proficiency in typing for keying in information and navigating in multiple systems Experience with computers including knowledge of Microsoft Word, Outlook, and Excel Requires long periods of sitting and telephone and computer work. Preferred Qualifications Data entry and documentation within member records Medical office experience Call center experience Medical terminology knowledge Strong telephonic communication skills Strong organizational skills with an ability to prioritize tasks to meet time-sensitive deadlines Effective verbal and written communications skills with both customers and teammates Education High School diploma, or equivalent GED Requisition Job Description Primary Job Duties & Responsibilities 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. Education High school diploma or 5+ years equivalent experience. Prior Relevant Work Experience 5+ years Essential Qualifications Adept at problem solving and decision making skills Job Description 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments . We anticipate the application window for this opening will close on: 09/15/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.