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Care Management Associate

Primary Location: Bismarck, ND
Additional Locations: ND-Bismarck
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Description:
  • Support comprehensive coordination of medical services including Predetermination intake, case screening, case prepping and multifunctional support of the daily processes associated with the Predetermination team.


Fundamental Components:
  • A Care Management Associate is responsible for the initial triage of clinical Predetermination work tasks including but not limited to: identification of case priority, identification of member or provider request types, identification of special or designated case handling; utilizing multiple end user systems and tools to identify and confirm eligibility and benefits along with provider participating status.
  • The Care Management Associate is also responsible for routing cases to specific work task buckets in ECHS (Electronic Case handling System) and or to licensed staff for determinations.
  • Additional responsibilities include handling member and provider outreach calls and urgent requests with minimal troubleshooting to resolve issues and the ability to escalate issues to licensed staff and management, as well as placing outbound calls to request additional information.
  • This position entails daily repetitious tasks.
  • This is a production based responsibility.


Background Experience:
  • 1-2 years experience in a customer service environment, preferably candidates with demonstrable insurance or medical office exposure.
  • Exposure or current usage of Aetna Total Clinical View (ATV) and Aetna Strategic Desktop (ASD) is desired but not required.


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.


Required Skills:
General Business - Turning Data into Information

Desired Skills:
Service - Demonstrating Service Discipline, Service - Working Across Boundaries, Technology - Leveraging Technology

Functional Skills:
Administration / Operation - Data Entry, Administration / Operation - Telephone / Receptionist

Technology Experience:
Aetna Application - Aetna Strategic Desktop Reporting, Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook

Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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

Candidate Privacy Information:
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.

Click To Review Our Benefits (PDF)

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