At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
The Care Management Associate (CMA) role is a full-time remote telework position. It is recommended that qualified candidates reside in Florida. This position manages enrollment for Aetna Better Health of Florida's Long Term Care population in addition to member engagement.
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The Care Management Associate supports our LTC Case Managers with new enrollee outreach, obtaining supporting documentations, contacting members for demographic confirmation and profile setup to promote effective case management and reporting.This position promotes/supports quality effectiveness of healthcare services. This is an 85% telework position and qualified candidate must be fluent in both English and Spanish. Schedule is Monday - Friday, 8am-5pm, standard business hours. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance to accommodate business needs.Position Responsibilities:
- Responsible for initial review and outreach of new monthly LTC enrollees. Outreach and promoting active connection through management of persistent outreach.
- Manages LTC Medicaid Redetermination and Eligibility concerns.
- Receives and compose Service Decision Review tasks for submission to MD.
- Ensures timeliness and efficiency of associated tasks and responsibilities.
- Completes outbound calls to members to obtain confirmation of enrollment and member's demographics.
- Utilizes Aetna systems to build, research and enter member information, as needed.
- Supports the development and implementation of FL LTC plan.
- Coordinates and arranges Service Decision Reviews for MD review. Provides delivery of decision under the direction of MD accordingly.
- Promotes communication to enhance effectiveness of care management services.
- Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
- Provides support services to team members by answering telephone calls, 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 contractual, regulatory, and accreditation requirements.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
- Demonstrates ability to meet daily metrics with speed, accuracy, and a positive attitude.
- 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, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).
- Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
- Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic, and caring presence telephonically.
- Must be fluent in English and Spanish
- 2+ Years of 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.
- 2+ years' demonstrated proficiency with personal computers, keyboard and multi-system navigation, and MS Office Suite application (Teams, Outlook, Word, Excel, etc.)
- Strong and effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
- Motivational interviewing skills
- Call Center experience
- Managed Care experience
- 1-4 years of experience in healthcare field or working in a medical office, hospital setting, case worker in community health setting.
- High school diploma or G.E.D.
40Time Type
Full timePay Range
The typical pay range for this role is:$18.50 - $31.72This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.