Care Management Associate

Job Description
Support comprehensive coordination of medical services including Care Team intake and outreach, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.

Fundamental Components
  • Responsible for initial review and outreach tasks.
  • Tracks Medicaid redetermination and researches eligibility issues.
  • Utilizes Dynamo, QNXT and other Aetna systems to build, research and enter member information, as needed.
  • Assists Case Managers with coordination of benefits 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 contract requirements.
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Background Experience
Must have:
  • Medicaid/ Medicare experience.
  • 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.
  • Familiarity with basic medical terminology and concepts used in care management.
  • Effective communication, telephonic and organization skills
  • 2-4 years' experience as a medical assistant, office assistant
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants.

    Additional Job Information
    Position requires an understanding of the Comprehensive Long-Term Care Program and covered benefits, DCF/SSI Medicaid benefits, familiarity with community resources, strong ability to multitask, and proactively trouble shoot to assist members who call with concerns. Requires effective triaging of case management needs, and commitment to follow regulatory compliance requirements.

    High School diploma, G.E.D. or equivalent experience

    Percent of Travel Required
    0 - 10%

    Business Overview
    At 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.