Care Management Associate
4755 South 44th Place Phoenix, AZ 85040 US
Job Description
Support comprehensive coordination of medical services including member transitions, screening, and supporting the implementation of referrals to promote effective utilization of healthcare services.
- Promotes/supports quality effectiveness of Healthcare Services.
- Create authorizations in QNXT to support continuity of care for members.
- Screen incoming forms 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.
- Coordinates and arranges for health care service delivery under the direction of nurse or medical director.
- Identify opportunities for the patient to utilize participating providers and services.
- Utilizes critical thinking and judgment to collaborate and inform the case management/concurrent review process.
- Facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education.
- Assist with authorization creation, appointment scheduling, and outreach to members, referral follow-up.
- Provide call center outreach to members related to referrals, gaps in care, and services needed.
- Assist with appointment scheduling, transportation scheduling, and referral assistance.
- Prior CVS/Aetna work experience: No
- Verifyable High School Diploma or GED Required: Yes
- Is this request for Peak Season? N/A - Not RAMP Related
- Does this position require Fingerprinting: Yes
- Is this an in-person, patient-facing role: No
- Onsite Requirements: Remote with future possibility of onsite
- High school diploma or GED required.
- 1-2+ years of call center experience.
- Benefits are available to full-time employees after 90 days of employment.
- A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.
- This is an AI-Formatted job description, therefore this does not remove human decision-making.