This is a telework position and qualified candidates must reside in and/or adjacent to one of the following assigned regions: Jefferson or Salt River Trail. Some travel (5% - 10%) may be required for visits to member homes and to the Louisville office for meetings and training.

Fundamental Components:

• Responsible for initial review and triage of Care Team tasks.
• Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.
• 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 entry of appropriate discharge date and disposition.
• Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
• Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
• Utilizes Aetna systems to build, research and enter member information, as needed.
• Support the Development and Implementation of Care Plans.
• Coordinates and arranges for health care service delivery under the direction of nurse 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).
• 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 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.
• May assist in the research and resolution of claims payment issues.
• Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.

Schedule:
M-F 8:00am to 5:00pm (Wednesday and Friday candidates must be available 7:00am to 7:00pm)

Pay Range
The typical pay range for this role is:
Minimum: 18.51
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

• 6+ months of being a medical receptionist
• Understanding of HIPPA compliance
• Must live in the Louisville area/Jefferson County

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

• Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
• Effective communication, telephonic and organization skills.
• Familiarity with basic medical terminology and concepts used in care management.
• 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.

Education

• High School Diploma or equivalent experience

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.