Aetna Care Management Associate in San Antonio, Texas

Req ID: 51282BR

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:

Responsible for initial review and triage of Care Team tasks;Identifies principle reason for admission, facility, and member product; 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.Utilizes eTUMS and other Aetna systems to build, research and enter member information, Performs non-medical research pertinent to the establishment, maintenance and closure of open cases. Provides support to members by answering telephone calls, taking messages, researching information and assisting in solving problems. Appropriately uses medical terminology Correctly interprets ICD 10 and CPT. Communicates effectively with clinicians at different levels by speaking credibly about medical/clinical/dental services Demonstrates basic understanding about the unique relationship between providers and patients needs

BACKGROUND/EXPERIENCE desired:

1-3 years experience as a medical assistant, office assistant Be proficient with computers and key board skills, to include Word, Outlook and Excel. Experience with Medical Terminology CPT/DX codes. Candidate must have strong verbal, written and communication skills. Candidate must be able to Toggle, through multiple programs open at one time and work well independently

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 - Customer Service/Call center monitoring & analysis - Inbound calls - call center location/1-3 Years

Functional - Customer Service/Customer Service - Plan Sponsor - Plan set-up - Traditional/1-3 Years

Functional - Clinical / Medical/Precertification/1-3 Years

Functional - Communications/Provider communications/1-3 Years

Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/Power User

Technical - EDI/EDI/1-3 Years/Power User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/Power User

Technical - Desktop Tools/Microsoft Word/1-3 Years/Power User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/FOUNDATION

Benefits Management/Understanding Clinical Impacts/ADVANCED

General Business/Turning Data into Information/FOUNDATION

DESIRED SKILLS

Benefits Management/Promoting Health Information Technology/ADVANCED

General Business/Communicating for Impact/ADVANCED

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.

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