Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. The mission of Aetna Better Health of LA (ABHLA) is to build a healthier world through better health, better care, and lower costs. We have embraced the quintuple aim as our guiding framework that integrates population health, equity, cost reduction, patient experience, and care team wellbeing into everything we do. We are leading the change by challenging the status quo with new technologies, VPB models, innovation, and integration of behavioral and physical health; and attracting and inspiring our local team by unlocking the power of our people to transform health care. Position Summary: The Care Management Associate (CMA) role is a full time remote telework position. Qualified candidates must reside in Louisiana. This position manages enrollment for foster, child and family welfare population health members, and carries a caseload. The Care Management Associate supports comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of Wellness Plans to promote effective utilization of healthcare services. This position promotes/supports quality effectiveness of healthcare services. Fundamental Components: • Responsible for initial review and triage of Care Team tasks. • Manages population health member enrollment for child and family welfare. • Manages a low tier member caseload. • Development of wellness plans, providing community resources, reviewing gaps in care, administering health questionnaires, and other targeted child welfare goals applicable to population health. • Completes outbound calls to identify and engage appropriate community resources. • Responsible for initial review and triage of Care Team tasks. • Screens 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 in accordance with the benefit plan. • Monitors non-targeted cases for entry of appropriate discharge date and disposition. • Identifies and refers outlier cases (e.g., length of stay) to clinical staff. • Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs. • Utilizes Aetna systems to build, research and enter member information, as needed. • Supports 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 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. • Manage population health member enrollment for child and family welfare. Development of Wellness Plan, providing community resources, reviewing gaps in care, administering health questionnaires, and other targeted child welfare goals applicable to population health. *Required Qualifications*: • Must reside in Louisiana. • 2-4 years' experience in healthcare field or working with foster, child and family welfare populations (e.g., experience in a medical office, hospital setting, case worker in community health setting). • 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, meting 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. • 2+ years demonstrated proficiency with personal computers, keyboard and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, etc.) • Flexibility to work occasional nights and weekends outside of standard business hours which can span from 8:00 am to 8:00 pm. *Education*: • High School Diploma or G.E.D. *Pay Range* The typical pay range for this role is: $18.50 - $31.72This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 05/10/2024
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