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Care Management Associate
CVS Health. Evaluate patients using targeted intervention rules and processes .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in patient evaluation, care coordination, and effective communication within healthcare settings. Capable of utilizing internal systems for documentation and compliance while maintaining member confidentiality and adhering to regulatory standards.
Highest-signal resume keywords
Patient EvaluationCare CoordinationMedical Terminology KnowledgeTelephonic Communication SkillsData Entry and Documentation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Typing ProficiencyData EntryDocumentation ManagementProblem-SolvingDecision-MakingMedical Office ExperienceCall Center ExperienceMicrosoft Office 365EHR Portal AccessVPN Access
Soft Skills
Organizational SkillsPrioritization SkillsEffective Verbal CommunicationEffective Written CommunicationJudgment and Critical Thinking
Tools & Technologies
Microsoft WordMicrosoft OutlookMicrosoft ExcelTeams MessagingVirtual Meeting ApplicationsMultiple Monitors Usage
Industry Keywords
Healthcare Service DeliveryRisk ManagementRegulatory ComplianceAccreditation StandardsCare Management
About the role
Key responsibilities & impact- Evaluate patients using targeted intervention rules and processes
- Identify needed medical services and make appropriate referrals
- Coordinate required services according to benefit plans
- Communicate health care service delivery based on nurse or medical director reviews
- Perform non-medical research for establishing, maintaining, and closing open cases
- Answer provider and member telephone calls and take accurate messages
- Review electronic transmissions and make referrals as appropriate
- Use internal tools to determine review steps based on clinical requirements and plan guidelines
- Maintain complete documentation meeting risk management, regulatory, and accreditation requirements
- Coordinate internal and external communication to enhance medical management services
- Obtain discharge dates and refer cases to the clinical team for follow-up
- Conduct initial review and triage of Care Team tasks
- Identify admission reason, facility, and member product to apply assessment tools
- Use Aetna systems to build, research, and enter member information
- Support development and implementation of care plans
- Coordinate health care delivery under nurse or medical director direction
- Identify opportunities to use participating providers and services
- Support hospital care, case management, and quality management processes
- Assist with research and resolution of claims payment issues
- Protect member confidentiality and comply with company policies, laws, and regulatory standards
- Work independently using judgment and critical thinking while meeting quality and productivity standards
Requirements
What you’ll need- Must be within an hour of New Albany, Ohio, Phoenix, AZ, or High Point, NC
- 2 years of experience in customer service, telemarketing and/or sales
- Proficiency in typing and navigating multiple systems
- Computer experience including Microsoft Word, Outlook, and Excel
- High school diploma or equivalent GED
- Alternatively, 5+ years of equivalent experience
- 5+ years of prior relevant work experience
- Problem-solving and decision-making skills
- Ability to work extended periods sitting and performing telephone and computer work
- Data entry and documentation within member records
- Medical office experience preferred
- Call center experience preferred
- Knowledge of medical terminology preferred
- Strong telephonic communication skills preferred
- Strong organizational and prioritization skills preferred
- Effective verbal and written communication skills preferred
- Direct/hardwired internet connection within 7 feet of modem/router, with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet not permitted
- Quiet, secure, private, compliant home workspace
- Must work within the state and city where currently living
- Ability to use multiple monitors and applications simultaneously
- Ability to use email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 or similar Google Workspace applications
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer security practices, manage strong passwords, and recognize suspicious emails or links
- Ability to troubleshoot common technical issues and contact IT when needed
- Openness to learning new skills
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment including keyboard, monitor, computer, and headset
- Remote work from home