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Care Managment Associate

Primary Location: Kalamazoo, Michigan
Additional Locations: MI-Kalamazoo
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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. WAH position; however, must reside in Kalamazoo, MI area. Working directly with care coordinators sending and picking mail up from USPS.

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.
  • Responsible for entering authorizations for paid care givers, Nursing facilities, Adult Foster Care Homes, DME. Completing special projects timely and with excellence is an important factor with this position.
  • Utilizes 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:
  • 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.
  • Strong Computer literacy in order to navigate through internal/external computer systems, including Outlook, Excel and Microsoft Word.
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants. The ability to multi-task and work independently with an excellent work ethic is required.


Required Skills:
General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices, Service - Handling Service Challenges

Desired Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Turning Data into Information, Leadership - Collaborating for Results

Functional Skills:
Administration / Operation - Data Entry, Administration / Operation - Mail Processing, Administration / Operation - Telephone / Receptionist, Information Technology - Computer operations, Medical Management - Medical Management - Administration/Management, Medical Management - Medical Management - Home health care

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel, Desktop Tool - Video Conferencing

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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