Care Managment Associate - Must live near Louisville, ...

Job DescriptionThis is full-time position working primarily remote and working in the Louisville office frequently. Qualified candidates will reside in the commutable distance to the Louisville office. This position will be for the Cumberland service region. 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. 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. Screens 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. Monitors non-targeted cases for entry of appropriate discharge date and disposition. Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff. Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs. 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 solvingproblems. Adheres to Compliance with PM Policies andRegulatory Standards. Maintains accurate and complete documentation ofrequired information that meets risk management,regulatory, and accreditation requirements. Protects the confidentiality of member informationand adheres to company policies regarding confidentiality. May assist in the research and resolution of claimspayment issues.Pay RangeThe typical pay range for this role is:Minimum: 18.50Maximum: 33.65Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsExperience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence- based practices applicable to the Kentucky SKY populations. Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Effective communication, telephonic and organizationalskills. Strong customer service skills to coordinate servicedelivery including attention to customers, sensitivity toissues, proactive identification and resolution of issues.Preferred Qualifications Familiarity with basic medical terminology and concepts used in care management. Ability to effectively participate in a multi-disciplinary team including internal and external participants. 2-4 years' experience as a medical assistant or officeassistantEducationHigh School Diploma or G.E.D.Business OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15