Aetna Care Management Associate in Scottsdale, Arizona
Req ID: 49117BR
Please note this is an in office position in Scottsdale, AZ. The hours are around 8:30-5:00 Monday- Friday.
As a Care Management Associate you will 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 for FEHBP FFS Plans. Promotes and supports quality effectiveness of healthcare services.
Fundamental components of the Care Management Associate position include, but are not limited to:
Performs intake calls from members, providers, facilities regarding services via telephone or fax Screens requests for appropriate referral to medical services staff Performs non-medical research pertinent to the establishment, 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, URAQ 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 referral into Case Management, Disease Management or 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
2-4 years experience as a medical assistant, office assistant or other clinical experience; RequiredStrong 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; RequiredComputer literacy - Microsoft Office Familiar with basic medical terminology; Required
The minimum level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
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