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Aetna is now a CVS Health Company

Care Management Associate

Primary Location: High Point, NC
Additional Locations: CT-Hartford, NC-High Point, PA-Bethlehem, UT-Sandy, VA-Chantilly
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Description:
  • 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.
  • Telephonic Position.


Fundamental Components:
  • Responsible for initial review and triage of Care Team tasks.
  • Identifies principle reason for admission, facility, and member product to 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.
  • Monitors non-targeted cases for entry of appropriate discharge date and disposition.Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.
  • Identifies triggers for referral into Aetna's Lifestyle conditioning coaching program Mixed Services, and other Specialty Programs.
  • Utilizes eTUMS and other Aetna systems to build, research and enter member information, as needed.
  • Support the Development and Implementation of Care Plans.
  • Coordinates and arranges for health care service delivery under the direction of nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
  • Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g.,health care providers, and health care team members respectively).
  • Performs non-medical research pertinent to the establishment, maintenance and closure of open cases.
  • Provides support services to team members by answering telephone calls, taking messages, researching information and assisting in solving problems.
  • Adheres to Compliance with PM Policies and Regulatory Standards.
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
  • May assist in the research and resolution of claims payment issues.
  • Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.


Background Experience:
  • 2-4 years experience as a medical assistant, office assistant.
  • High School Diploma or G.E.D.


Additional Job Information:
  • Care Management Associates with an interest in Aetna's Lifestyle and Condition Coaching Program -You'll play an essential role in assisting the nurses/coaches in the development of effective and efficient care coordination and self care for our members
  • The Care Management Associates will be responsible for making outreach calls to members who are eligible for our programs
  • Manage inbound call activity
  • Initial review of tasks and other administrative type activities that support the unit
  • The ideal candidate should have strong customer service skills
  • Effective communication, telephonic and organizational skills
  • Candidates will need effective time management, ability to manage multiple priorities
  • Strong teamwork skills
  • Must possess strong computer and keyboarding skills
  • 2-4 years’ experience in telephonic customer service preferred

ADDITIONAL JOB INFORMATION: required to work flexible hours required. Business hours 8:00am-11:00pm EST Work hours 8:00am-4:30pm ET 3 -4 day shifts,1- 2 evening shifts ( with rotating Fridays).

Required Skills:
Benefits Management - Interacting with Medical Professionals, Service - Demonstrating Service Discipline, Service - Working Across Boundaries

Desired Skills:
Service - Handling Service Challenges, Technology - Leveraging Technology

Functional Skills:
Customer Service - Call center monitoring & analysis - Inbound calls - call center location, Customer Service - Customer Service - Outbound calls - survey administration

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - TE Microsoft Excel

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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