Care Management AssociatePrimary Location: High Point, NC
Additional Locations: NC-High Point Apply
- Responsible for helping to support day to day operations of the High Point Unit.
- Responsibilities will include but not limited to: Badge access coordinator, case distribution, sorting and sending mail, ordering supplies, checking hotel stations, receiving new hires and giving unit tour, conference room set up for onsite meetings, ensuring new hire set ups are complete prior to new hires starting.
- This role will be need to be flexible to the business needs of the unit.
- Responsible for initial review and triage of Care Team tasks.
- Identifies triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs. Utilizes Aetna systems to build, research and enter member information.
- 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.
- Supports the 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.
- 2-4 years experience as a administrative assistant, medical assistant, office assistant.
- High School Diploma or G.E.D.
- Effective communication, telephonic and organization skills.
- 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.
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