Aetna Care Management Associate in Phoenix, Arizona

Req ID: 43802BR

POSITION SUMMARY

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:

  • 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

    BACKGROUND/EXPERIENCE desired:

    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

    Computer literacy

    Familiar with basic medical terminology

    EDUCATION

    The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.

    FUNCTIONAL EXPERIENCES

    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

    TECHNOLOGY EXPERIENCES

    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

    REQUIRED SKILLS

    General Business/Maximizing Work Practices/ADVANCED

    Service/Handling Service Challenges/FOUNDATION

    Service/Providing Solutions to Constituent Needs/ADVANCED

    DESIRED SKILLS

    Benefits Management/Promoting Health Information Technology/ADVANCED

    Service/Creating a Differentiated Service Experience/ADVANCED

    Service/Demonstrating Service Discipline/FOUNDATION

    Telework Specifications:

    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