Care Management Associate

Job DescriptionNormal working hours are Monday through Friday from 12:30pm - 9:00pm EST.There are occasional Saturday, Sunday and holiday shifts which are currently filled on a volunteer basis. If these shifts become required, it will be approximately one weekend shift per quarter and 1 holiday per year but the frequency will be per the need of the department. There is no travel required with this position. This position is 100% remote and work from home. Employee can live in any state. 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: -Responsible for initial review and triage of Care Team tasks. -Identifies principle 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. -Support 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 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 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-Experience with computers including knowledge of Microsoft Word, Outlook, and Excel-Proficiency in typing for keying in information and navigating in multiple systems-Requires long periods of sitting and telephone and computer work.-2 years of experience in either customer service, telemarketing and/or salesCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively 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 teammatesEducationHigh School diplomaBusiness OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-09-06