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Aetna Care Management Associate (WAH in State of Arizona) in Casa Grande, Arizona

Req ID: 65346BR

Job Description

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.

Fundamental Components included but are not limited to:

  • Responsible for initial review and triage of Care Team tasks.

  • Identifies principle reason for admission, facility, and member product to correctly apply intervention assessment tools.

  • Screens patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff and coordinate the required services in accordance with the benefit plan.

  • Identifies triggers for referral into Mercy Care's Case Management and care coordination programs.

  • Utilizes Mercy Care systems to document interventions, research and enter member information, as needed.

  • Supports the Development and Implementation of Care Plans.

  • Coordinates and arranges for health care service delivery under the direction of nurse or behavioral health care manager in the most appropriate, least restrictive setting by identifying opportunities for the patient to utilize participating providers and services.

  • 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 taking member calls, 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.

  • Supports the administration of care management and quality management processes in compliance with various laws and regulations while adhering to company policy and procedures.

Qualifications Requirements and Preferences:

  • 2-4 years experience as a medical assistant, office assistant.

  • High School Diploma or G.E.D.

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Required Skills:

Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, Technology - Leveraging Technology

Desired Skills:

Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Understanding Clinical Impacts, Service - Handling Service Challenges

Additional Job Information:

  • 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.

  • Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

  • Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.