Care Management Associate
CVS Pharmacy - Pittsburgh, PA
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Job DescriptionThis group provides support services, such as Document Imaging, Data Entry, Administrative Support (limited) and Mail. They make sure these behind-the scenes business activities run smoothly on a daily basis. Provide the office support needed to ensure that business objectives this role, you will be responsible for: Triages and troubleshoots incoming calls for proper business unit assignment (NACMST, customer service, member services, appeals, etc) Liason for external providers to advocate for members. 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. Ability to effectively participate in a multi-disciplinary team including internal and external participants 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. Identifies applicable platform for P2P(Peer to Peer) incoming calls, triages cases utilizing ATV and MedCompass and other Aetna systems to build, research and enter member information to support the development of MD tasks including pertinent details regarding MD call backs. Triage calls for turnaround timeframes, notate applicable information as case requires. Identifies and performs referral of Medicare or Commercial appeals cases via the CATs system to the applicable territory, market and MD. Where applicable ascertain proper MD board certification and MD licensure prior to assignment based upon AOC grid. Knowledge of: Word, Outlook, Excel, Customer ServicePay RangeThe typical pay range for this role is:Minimum: 18.50Maximum: 34.60Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- 2+ years of customer service experience- 2+ years of call center experience - 2+ years of Microsoft Office experiencePreferred Qualifications- Healthcare experience- Strong attention to detailEducationHS degree or GEDBusiness OverviewBring 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.
Created: 2024-09-07