Care Management Associate_

New Albany

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

Aetna One Advocate is Aetna’s premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors. The high-touch, high-tech member advocacy service combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join Aetna, a CVS Health company, in our journey to change the way healthcare is delivered today. We are health care innovators.

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.

- This Care Management Associate position role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in New Albany, Ohio. There is a requirement to live within a commutable distance of New Albany, Ohio (typically within 45 minutes maximum).

- The initial in office training will last for approximately 3 months. Once office training is complete, the role is work from home with occasional in office workdays scheduled in advance with the employee.

- There will be an expectation that the Care Management Associate works in the office at least one time per quarter for further training but it may be more often, and notice will be provided.

- Normal Working Hours: 8:00 AM to 4:30 PM Eastern Standard Time ( EST.) Once training is completed, the Care Management Associate will work occasional later shifts per month on a team rotation. There are no weekend shifts. There is no travel required with this position.

Required Qualifications

- 1 year 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

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. 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. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 06/28/2024

We are an equal opportunity and affirmative action employer. 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.