Job Description

Support comprehensive coordination of medical services including Case Management intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. Responsible for initial review and triage of Case Management 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 discharge date and disposition and informs primary CM of impending discharges.
Coordinates and arranges for health care service delivery under the direction of nurse, LCSW 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). 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. Supports the administration of the case management and quality management processes in compliance with various laws and regulations, while adhering to company policy and procedures.

Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 34.60

Please 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

• Minimum of 2 years experience in Customer Service role, preferably in medical field.
• Two years experience in managed care or population health
• Bilingual, English/Spanish required.

Preferred Qualifications

• Two years in medical field role preferred.
• Medicare experience preferred.

Education
High school diploma or G.E.D.

Business Overview
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 \xe2\x80\x94 with heart at its center \xe2\x80\x94 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\xe2\x84\xa2 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.