Care Management Associate (OK REMOTE)-1

About the position 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. Position Summary Aetna’s Medicaid Care Management Engagement Outreach Hub is a new initiative focused on prioritizing Medicaid member interaction, maximizing inbound and outbound touchpoints to solve members’ needs and create behavioral change. How we do this is through a dedicated and caring team of health care professionals who connect with passion, caring and behavioral interviewing techniques. This team has a drive to exceed the delivery of Medicaid Health care services. Focus is on the Hub’s efficiency and productivity efforts whereby the Care Management Associates interact and engage telephonically with members. Through the successful supports orchestrated by the Hub team, this comprehensive care coordination is a collaborative demonstration of innovative healthcare navigation and motivational health plan customer support representation. 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 Engagement Outreach Hub Care Management Associate supports comprehensive coordination of healthcare services through telephonic outreach to and enrollment of our eligible members. Our Engagement Care Management Associates demonstrate a highly energetic blend of salesperson, healthcare navigator and health plan customer support representative. The Associate is responsible for direct member outreach and engagement, facilitating case assignment, and connecting identified members to care managers immediately through a warm transfer. By successfully enrolling members into care management, further supports the implementation of care plans to promote effective utilization of healthcare services, promoting and supporting quality effectiveness. 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 procedure/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.

Responsibilities

• direct member outreach and engagement
• facilitating case assignment
• connecting identified members to care managers immediately through a warm transfer
• enrolling members into care management
• supports the implementation of care plans to promote effective utilization of healthcare services
• promoting and supporting quality effectiveness
• 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 procedure/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.

Requirements

• 2 years’ experience in healthcare field (i.e. experienced in medical office, hospital setting, medical billing/coding)
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel – data entry and documentation within member records
• Familiarity with basic medical terminology and concepts used in care management
• Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm.
• Strong organizational skills, including effective verbal and written communication skills.

Nice-to-haves

• Bilingual (Spanish) preferred, must have ability to pass a written and oral exam.
• 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.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

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