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CVS Health Care Management Associate in Arizona

Job Description

This position is a subject matter expert and provides assistance and direction for staff of fax processors and phone representatives who create Prior Authorization based on requests from providers. At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We’re a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 we’re going to begin delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let’s work together to make a difference and improve the health and wellbeing of Arizona. Candidate will be responsible for the following;- Coaching the team on the process for creating an authorization and following up with the rep when errors are created.- Gathering data on a daily and weekly basis for production reports.- Completing audits on the team ensuring authorizations are completed timely and efficiently. - Working closely with the supervisor to train new processes and help the team adapt to changes- Supporting the team with questions that come up during the process of creating authorization.- Assuming responsibility of escalated calls/situations these authorizations. 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.

Required Qualifications

1 - 3 years experience in Prior Authorization or a related department- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.- Ability to effectively participate in a multi-disciplinary team including internal and external participants.- 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.

Preferred Qualifications

1-3 years experience in a heath care setting


High school diploma or GED

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.