Thomas Jones

Experience

1. Care Management Associate

   CVS Health

   Jul 2024 — Present · Charleston, WV, US

   Supports coordination of medical services, including Care Team intake, screening, and implementation of Wellness Plans to promote effective utilization of healthcare services.• Responsible for initial review and triage of members.• Develop wellness plans, provide community resources, review gaps in care, administer health questionnaires, and implement other targeted child welfare goals applicable to population health.• Completes outbound calls to identify and engage appropriate community resources.• Screens members using intervention business rules and processes to identify needed medical services, make referrals to medical services staff, and coordinate the required services in accordance with the benefit plan.• 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.• Coordinates and arranges for health care service delivery under the direction of a 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 the effectiveness of medical management services.• Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases.• 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.

Education

• Virginia Triumphant College and Seminary

  Master's degree

• Adjuster Pro

  Insurance Claims

  2020 — 2020

• Virginia Triumphant College and Seminary

  Bachelor's degree