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Client Services Specialist - RISE Care Management Associate

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Client Services Specialist - RISE Care Management Associate

  • Location:

    Scotia

  • Sector:

    MRS Medical

  • Job type:

    Temporary & Contract

  • Salary:

    Negotiable

  • Contact:

    Dominique John Parole

  • Contact email:

    dparole@medicalrecruitmentstrategies.com

  • Job ref:

    BBBH410497_1672765433

  • Published:

    25 days ago

  • Expiry date:

    2023-04-03

Remote/Work from Home! Exciting Job Opportunity as Client Services Specialist II - OhioRISE Care Management Associate for CVS Health

We, at Medical Recruitment Strategies is in need of Client Services Specialist II - OhioRISE Care Management Associate for CVS Health (Remote, Contract)

Job Title: Client Services Specialist II - OhioRISE Care Management Associate

Job Location: Remote/Work from Home but requires travel to the New Albany office with some frequency; up to 25% of the time to attend meetings, trainings, special projects, and to perform other in-office tasks.

Shift: Monday - Friday, Normal Business Hours

Pay Rate: $20/HR

Job Period: January 3, 2023 - July 2, 2023

Training: (intensive)

  • 3 weeks - 1 month
  • Care Management Foundations (2-3 weeks)
  • Dynamo (Electronic Health Records systems) (1-2 weeks)
  • Interacting / Initial conversations with Medicaid population
  • Navigating challenging conversations


As a Client Services Specialist II - OhioRISE Care Management Associate, your key responsibilities would include but are not limited to:

  • Responsible for initial review and triage of Care Team
  • Identifies principal 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.

Experience / Qualification required:

  • High School Diploma or GED
  • 2-4 Years of experience as a Medical Assistant
  • Call center experience, documenting, medical terminology, computer experience
  • Managed Care and Medicaid experience is a plus
  • 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.
  • Demonstrated proficiency with personal computers, keyboard and multi-system navigation, and MS Office
    Suite applications (Outlook, Word, Excel, SharePoint, etc.)
  • Ohio residency; must reside within proximity/commutable distance to the New Albany office address.
  • Ability to travel to the office as required. Must possess reliable transportation, valid and active driver's license, and proof of vehicle insurance

Please submit your most recent resume together with time of availability and updated contact number for a brief interview. Thank you!