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About the Role
The Care Management Associate (CMA) supports comprehensive coordination of medical services, including intake and outgoing calls. This role works closely with case management and utilization management teams to review eligibility and benefits, open pre-certification cases, and approve or escalate cases for nursing review.
Responsibilities
- Supports comprehensive coordination of medical services that include intake and outgoing calls for medical services.
- Works closely with both case management and utilization management teams.
- Reviews eligibility and benefits, opens pre-certification cases, and either approves or sends to nursing staff for review.
- Evaluates 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 by the benefit plan.
- Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director.
- Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.
- Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropriate.
- Utilizes internal tools to determine required steps to ensure proper review based on clinical requirements as well as established plan guidelines.
- Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
- Ensures communication, both internally and externally, to enhance the effectiveness of medical management services.
- Assists in obtaining discharge dates and making appropriate referrals to clinical team for their engagement in additional follow up as needed.
- Completes work independently on occasion while executing good judgment and critical thinking skills while adhering to Department guidelines, policies, and procedures.
- Operates with a sense of urgency and flexibility to meet the needs of a rapidly changing environment, while meeting performance standards set for quality and quantity of work.
Requirements
- 2 years’ experience as a medical assistant, office assistant or related experience.
- Minimum of 6 months of call center experience required.
Skills
- Effective communication skills.
- Telephonic skills.
- 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 to navigate through Internal/external computer systems, including Excel and Microsoft Word.
- Good judgment.
- Critical thinking skills.
Location
- Central time schedule
Work Type
- Full time
Experience Level
- 2 years experience
- 6 months call center experience
Education Level
- High School Diploma or equivalent GED
Salary/Compensations
- $18.50 - $35.29 per hour
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
About the Company
- We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.
- At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
- Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
- 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.
Equal Opportunity
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.