Care Management Associate - Must reside in Miami Florida

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Care Management Associate (CMA) role is a full-time remote telework position. It is recommended that qualified candidates reside in Florida. This position manages enrollment for Aetna Better Health of Florida’s Long Term Care population in addition to member engagement.

The Care Management Associate supports our LTC Case Managers with new enrollee outreach, obtaining supporting documentations, contacting members for demographic confirmation and profile setup to promote effective case management and reporting.

This position promotes/supports quality effectiveness of healthcare services. This is an 85% telework position and qualified candidate must be fluent in both English and Spanish. Schedule is Monday – Friday, 8am-5pm, standard business hours. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance to accommodate business needs.

Position Responsibilities:

• Responsible for initial review and outreach of new monthly LTC enrollees. Outreach and promoting active connection through management of persistent outreach.

• Manages LTC Medicaid Redetermination and Eligibility concerns.

• Receives and compose Service Decision Review tasks for submission to MD.

• Ensures timeliness and efficiency of associated tasks and responsibilities.

• Completes outbound calls to members to obtain confirmation of enrollment and member’s demographics.

• Utilizes Aetna systems to build, research and enter member information, as needed.

• Supports the development and implementation of FL LTC plan.

• Coordinates and arranges Service Decision Reviews for MD review. Provides delivery of decision under the direction of MD accordingly.

• Promotes communication to enhance effectiveness of care management services.

• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.

• Provides support services to team members by answering telephone calls, 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 contractual, regulatory, and accreditation requirements.

• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

• 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, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic, and caring presence telephonically.

Required Qualifications

• Must be fluent in English and Spanish
• Must reside in Miami Florida
• 2+ Years of 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.
• 2+ years’ demonstrated proficiency with personal computers, keyboard and multi-system navigation, and MS Office Suite application (Teams, Outlook, Word, Excel, etc.)
• Strong and effective communication, telephonic and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.

Preferred Qualifications

• Motivational interviewing skills