Aetna Care Management Associate in Phoenix, Arizona
Req ID: 43802BR
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.
Performs intake calls from members, providers, facilities regarding services via telephone or fax
Screens requests for appropriate referral to medical services staff
Performs non0medical research pertinent to the establishes, maintenance and closure of open cases
Maintains accurate and complete documentation of required information that meets risk management, regulatory and accreditation requirements
Promotes communication both internally and externally to enhance effectiveness of medical management services
Protects the confidentiality of member information and adheres to company policies regarding such
Supports the administration of the precertification process in compliance with various laws and regulations, URAC and/or NCQA standards where applicable
Places outbound calls to providers under the direction of medical management nurses to obtain clinical information for approval of medical authorizations
Identifies triggers for referrals into Case Management, Disease Management and other Special Programs
May assist in the research and resolution of claims payment issues
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
2+ years experience as a medical assistant, office assistant or other clinical experience
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 customers
Familiar with basic medical terminology
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
Functional - Administration / Operations/Data Entry/1-3 Years
Functional - Administration / Operations/Telephone / Receptionist/1-3 Years
Functional - Customer Service/Customer Service - Member Services - HMO products/1-3 Years
Functional - Customer Service/Customer Service - Member Services - Traditional products/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
General Business/Maximizing Work Practices/ADVANCED
Service/Handling Service Challenges/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
Benefits Management/Promoting Health Information Technology/ADVANCED
Service/Creating a Differentiated Service Experience/ADVANCED
Service/Demonstrating Service Discipline/FOUNDATION
Option for telework will be evaluated after a certain period of employment
Telework considered only for unique circumstances
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care