About the Role
Title: Behavioral Health Care Planner
Remote
UT – Work from home
Work At Home-Arizona
Work At Home-North Dakota
Work At Home-Minnesota
CA – Work from home
Work At Home-Nebraska
Work At Home-New Mexico
Work At Home-Missouri
Full time
JobDescription:
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.
Position Summary
Shift available: 9:00 AM to 5:30 PM Pacific Standard Time
Care Planner position would work within the Commercial and IFP membership of the Behavioral Health Division of Aetna/CVS. Would work closely with Medical Directors, Clinicians and Customer Service to process higher level reviews.
The Care Planner would be an integral part of managing our state policies, our NCQA accreditation, and helping our members get the help and documentation that they need.
Additional responsibilities to include but limited to the following:
– Provide service to clinical teams in support of optimal care.
– Generates administrative and medical necessity denial letters, checking for accuracy and appropriateness.
– Makes calls to providers and utilization reviewers to provide results of medical necessity determinations and provides specifics for next steps.
– Schedules and coordinates appointments between providers or attending physicians and Aetna Medical Directors or Consultants.
– Collects and provides necessary material for appointments. Calculates deadlines for appointments and monitor cases for timely return.
– Complies with state mandated and Aetna regulations by monitoring documentation, checks for nuances before action taken and follows varying protocols by case or situation.
Required Qualifications
– 2 plus years experience in health insurance field or
– 2 plus years Administrative/ Secretarial experience or
– 2 plus years Customer service experience within health care or a mental health capacity
– Ability to type 60-70 words per minute
– Demonstrated knowledge and experience using Microsoft Office Suite, including: Outlook, Word, and Excel
Preferred Qualifications
– Good organizational skills
– A go-getter who works independently
– Excellent communication
Education
Associates degree or equivalent experience