CVS Health Care Management Associate in Illinois
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country.Position Summary/MissionThe Care Management Associate support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans topromote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services.Fundamental Components • Responsible for initial review and triage of Care Team tasks.• Identifies principle reason for admission, facility, and member product tocorrectly apply intervention assessment tools.• Screens patients using targeted intervention business rules and processesto identify needed medical services, make appropriate referrals to medicalservices staff and coordinate the required services in accordance with thebenefit plan.• Monitors non-targeted cases for entry of appropriate discharge date anddisposition.• Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.• Identifies triggers for referral into Aetna's Case Management, DiseaseManagement, Mixed Services, and other Specialty Programs.• Utilizes eTUMS and other Aetna systems to build, research and entermember information, as needed.• Support the Development and Implementation of Care Plans. • Coordinates and arranges for health care service delivery under the direction of nurse ormedical director in the most appropriate setting at the most appropriateexpense by identifying opportunities for the patient to utilize participatingproviders 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 solvingproblems.• Adheres to Compliance with PM Policies and Regulatory Standards.• Maintains accurate and complete documentation of required informationthat meets risk management, regulatory, and accreditation requirements.• Protects the confidentiality of member information and adheres to companypolicies regarding confidentiality.• May assist in the research and resolution of claims payment issues.• Supports the administration of the hospital care, case management andquality management processes in compliance with various laws andregulations, URAQ and/or NCQA standards, Case Management Society ofAmerica (CMSA) standards where applicable, while adhering to companypolicy and procedures. (*)
2-4 years experience as a medical assistant, office assistant.
Please see requirements above
High School Diploma or G.E.D.
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.
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