• Support comprehensive coordination of medical services including Care Team intake and outreach, 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 outreach tasks.
• Tracks Medicaid redetermination and researches eligibility issues.
• Tracks and ensures Level of Care compliance standards set by the State.
• Utilizes Dynamo, QNXT and other Aetna systems to build, research and enter member information, as needed.
• Assists Case Managers with coordination of benefits 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 contract requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.

Pay Range
The typical pay range for this role is:
Minimum: 18.50
Maximum: 33.65

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

• 1+ years experience as a medical assistant, office assistant or member services representative.
• 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.
• Effective communication, telephonic and organization skills.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

• Familiarity with basic medical terminology and concepts used in care management.
• Medicaid/ Medicare experience preferred.

Education
High School diploma or equivalent

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 — 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.