Job Information
CVS Health Care Management Associate in Harrisburg, Pennsylvania
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.
Work from home anywhere - 12:30 PM - 9:00 PM EST
Position Summary
Provide comprehensive healthcare management to facilitate delivery of
appropriate quality healthcare, promote cost effective outcomes and
improve program/operational efficiency involving clinical issues.
Support 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 eTUMS and other 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
Effective communication, telephonic and organization skills.
Familiarity with basic medical terminology and concepts used in care
management.
Strong customer service skills to coordinate service delivery including
attention to customers, sensitivity to issues, proactive identification and
resolution of issues to promote positive outcomes for members.
Computer literacy in order to navigate through internal/external computer
systems, including Excel and Microsoft Word.
Ability to effectively participate in a multi-disciplinary team including internal
and external participants.
Preferred QualificationsCall Center Experience
EducationHS Diploma
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: 05/20/2024
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.