Aetna Care Management Associate in New Albany, Ohio
Req ID: 37868BR
This position will be held out of the New Albany, OH office, no opportunity for telework.
Support comprehensive coordination of the In Touch Care Management program including but not limited to intake, screening, researching and collecting information, performing initial member outreach, scheduling appointments, supporting the implementation of care plans to promote effective utilization of healthcare services, and/or referring members to specialty programs as appropriate, such as Behavioral Health or Womens Health programs. Performs intake of calls from members or providers regarding services via telephone, fax, EDI. Utilizes ASD/ATV and other Aetna systems to build, research and enter member information. Approve services that do not require a medical review in accordance with the benefit plan. Performs non-medical research including eligibility verification, COB, and benefits verification. Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
Familiarity with basic medical terminology and concepts used in care management. Support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. Effective communication, telephonic and organization skills. Sedentary work involving significant periods of sitting, talking, hearing and keying. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions.
Hours of operation are 8:00 AM -10:00 PM EST. (CMA scheduled shifts vary to cover hours of operation). Evenings 1:30 PM -10:00 PM 1-2 rotations a month.
2-4 years experience as a medical assistant, office assistant. proficient with navigation thru multiple systems and dual monitors ability to touch type at efficient speed.
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Functional - Customer Service/Customer Service - Member Services - Traditional products/1-3 Years
Functional - Customer Service/Customer service - Medical Transcription/1-3 Years
Functional - Customer Service/Customer service - Medical billing/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/FOUNDATION
Service/Creating a Differentiated Service Experience/ADVANCED
Service/Handling Service Challenges/FOUNDATION
Service/Demonstrating Service Discipline/FOUNDATION
Service/Working Across Boundaries/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Function: Health Care