Sr Analyst Newborn Coordinator - Field, Must Live In Dc, Md Or Va

• Facilitate the resolution of claims for services provided to newborns and/or direct a provider to the appropriate claims contact for assistance.
• Coordinate and authorize out of network care in the case where the MCO cannot offer the newborn an appropriate in-network provider.
• In accordance with MCO protocols, coordinate and authorize in-network care in the case where the newborn does not yet appear in the MCO's system.
• Facilitate and confirm a PCP selection for a newborn whose PCP assignment is in question.
• Coordinate with the MCOs ancillary provider networks, such as pharmacy and durable medical equipment, to facilitate the appropriate delivery of care for a newborn whose eligibility may be of question and/or whose primary care provider of record did not authorize or prescribe a service.
• Provide general guidance to providers and office staffs on newborn related issues.
• Make retroactive PCP enrollment and capitation adjustments where necessary.
• Interface with Benova, the Maternal Child Health Hotline, the NC's that involve multiple MCOs.
• Request an ID card for a newborn.
• Research the eligibility of a newborn whose MCO assignment is in question and confirm for the provider the MCO to which the newborn belongs.

Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 100,000
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit

jobs.CVSHealth.com/benefits

Required Qualifications

• Meet all requirements set forth by local state i.e. first aid, CPR, TB screen
• Remote with some field work
• Background in a health care environment
• Experience: 5-7 years of prior relevant experience
• Experience using technology specifically use of Excel and Electronic Health Records.

Preferred Qualifications

• Preferred skills: Mental Health First Aid, Trauma Informed Care, HIPPA, C.L.A.S. Standards, Motivational Interviewing, and specialized training in medical terminology and practices for designated health conditions.
• Experience in serving the Medicaid Populations in urban or rural environments with familiarity of local formal and informal resource networks preferred.
• 1-2 years’ experience providing clinical services; experience in community/outpatient setting preferred.
• Bachelor's or above preferred

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. 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.