Next Best Action AdvocatePrimary Location: Harrisburg, PA
Additional Locations: PA-Harrisburg Apply
- Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
64248Fundamental Components: Improved Health Care Decision Making:
- Through the use of information/data review, conducts evaluation of member’s needs/eligibility and outreaches for one-time campaigns, focused on driving improved health care decisions around topics such as selection of the best lab facility or options for immediate care beyond the emergency room, reminders for preventative health screenings, and compliance with medications.
- Utilizes highly developed consultative skills with a focus on verbal and written communications, listening and questioning techniques, and the ability to quickly build trust and influence in support of a member’s improved health outcomes.
- Provides information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Enhancement of Member Impact:
- Demonstrate an outgoing, enthusiastic, and caring presence over the telephone to engage in meaningful and relevant conversations with each member, adjusting the conversation to reflect the information being shared by the member, and keeping the focus on improved health outcomes.
- Influences in a caring and supporting manner that results in behavior change and adoption of each campaign’s goal.
- Effectively support members during calls, appropriately managing difficult of emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate.
- Identifies appropriate scenarios for member transfer to Member Services, Clinical colleagues, or other Case Management teams within Aetna to support members’ comprehensive health needs.
- Demonstrates experience with technology-based interactions, including video, email, text, etc. and omni-channel campaigns.
- Utilizes Aetna systems to build, research, and enter member information; perform non-medical research pertinent to establishment, maintenance, and closure of open cases.
- Accurately and consistently documents each call in the member’s electronic records, thoroughly completing required actions with a high level of detail.
- Exhibits impact-oriented mindset, and enthusiasm working in a fast paced, agile team environment.
- 2 years experience in customer service, retail or inside sales, telemarketing or health coaching is preferred.
- Call center experience preferred. Familiarity with basic medical terminology preferred.
- Bilingual language skills are a plus (e.g. Spanish).
- Bachelor’s degree required.
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