CVS Health Care Management Associate in Salt Lake City, Utah
WAH in CST, MST or PST time zones
Support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services.
Promotes/supports quality effectiveness of Healthcare Services.
Full or Part Time:
Percent of Travel Required:
0 - 10%
Posting Job Title:
Care Managemement Associate - WAH
Potential Telework Position:
AZ-Phoenix, CA-Fresno, IL-Chicago, KS-Wichita, MO-Kansas City, OH-New Albany, TX-San Antonio, UT-Salt Lake City
Primary Location (City, State):
Aetna is an Equal Opportunity, Affirmative Action Employer
Additional Job Information:
Effective communication, telephonic and 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 in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Responsible for initial review and triage of members with maternity members for high-risk maternity program.
Screens patients using targeted intervention business rules and processes to identify needed high risk nurse case management and coordinate the required services in accordance with the benefit plan.
Utilizes ATV and other Aetna systems to build, research and enter member information, as needed.
Support the Development and Implementation of Care Plans.
Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers 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 PM Policies and 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.
May assist in the research and resolution of claims payment issues.
Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.
2-4 years experience as a medical assistant, office assistant.
High School Diploma or G.E.D.
Benefit eligibility may vary by position.
Candidate Privacy Information:
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Clinical Licensure Required: